Cambridge English For Nursing 1 PDF

CAMBRIDGE
Cambridge English for
Nursing
Virginia Allum
and Patricia McGarr
Senes Editor : Jeremy Day
Introduction
The aim of Cambridge English for Nursing are to improve your communication skills at work and
your English language knowledge in key areas of nursing. To give you practice in current healthcare
situations, each of the ten units contains:
discussion of the nursing topic
listening activities reflecting everyday nursing scenarios
a focus on communication, for example giving advice sensitively
a medical focus, for example describing how the heart works
charting and documentation - medical forms and how to use them
abbreviations and acronyms used in healthcare
an online glossary with a pronunciation guide
On the audio you hear people in the kind of healthcare situations that you encounter as a nurse, for
example admitting a patient, explaining medical procedures, discussing lifestyle changes, handing over
patients, taking part in training sessions, preparing a pre-op patient, and dealing with young patients
in pain. In addition, online activities focusing on advances in technology will help you keep up - to -date
with the latest medical equipment.
How to use Cambridge English for Nursing for self- study

If you are working on your own, you can do the units in any order you like. Choose the topic that
you want to look at and work through the unit doing the exercises and checking your answers in the
answer key. Note down any mistakes you make, and go back and listen or read again to see what
the problem was. It’s a good idea to listen to the audio more than once and to read the audioscript
afterwards to check that you’ve understood. For the speaking activities, think about what you would
say in the situation. You could also try talking about the discussion points with your colleagues; the
topics are all relevant for people who work in healthcare. Audioscripts and a comprehensive answer
key with solutions to the activities as well as suggested answers for the discussion tasks are at the
back of the book. In addition, you can find extra material and further activities for practice online at
www.cambridge.org/ elt/englishfornursing.
We hope you enjoy using the course. If you have any comments on Cambridge English for Nursing ,
we’d love to hear them. You can email us at [email protected].
\J
Virginia Allum (BA , MA , Cert TESOL, Certificate in Nursing) lives and works in Australia and has extensive
experience as a Registered Nurse working in hospitals in Sydney and on the Gold Coast. She also has palliative
care experience gained while working as Director of a home nursing service in Sydney. She has taught English 'or
nursing at a vocational training institute in Queensland and also works as a Lecturer and Nurse Facilitator in the
diploma of nursing at the Gold Coast Institute of TAFE (Technical and Further Education) in Queensland
I Patricia McGarr (B Ed. Dip TESOL, MA TESOL, MBA) lives in Australia and works at Griffith University She nas
wide -ranging international teaching experience, having managed a network of language institutes in Asia protect
,
managed specialised English courses in Kuwait and Oman , and been instrumental in setting up ndustryspeohc
language projects in Vietnam and China. She managed the Insearch Language Centre. University of Technology-
Sydney - one of the largest English language institutes in Australia - and set up several ofsnore Drograms that
they delivered in Asia.
Skills Medical focus Charting and
documentation
Taking a patient history The heart Patient Admission Form
UNIT 1 Using active listening strategies Explaining how the heart Patient Record
Patient Explaining how the heart works works Observation Chart
admissions Putting a patient at ease
page 6 Giving a nursing handover
Charting blood pressure and
pulse
Educating patients about asthma The respiratory system Respiratory rates

UNIT 2 management Patient record
Respiratory Giving instructions effectively Observation chart
problems Using a nebuliser
page 14 Talking to a child about asthma
Putting a young patient at ease
Describing respiration
Charting respiratory rates
Discussing wound management Wound bed preparation Wound Assessment Chart

UNIT 3 Asking for advice
Wound care Describing wounds
page 22 Taking part in Continuous
Professional Development
Using a Wound Assessment Chart.
Discussing diabetes management The pancreas Diabetic Chart.

UNIT 4 Making empathetic responses Explaining hypoglycaemia
Diabetes care Giving advice sensitively and diabetes
page 30 Using a Diaoetic Chart
Explaining pathology tests The kidneys Pathology Report

UNITS Asking for clarification Explaining renal failure
Medical Checking understanding Explaining urinary
specimens Telephone skills: contacting other catheters
page 38 staff
Softening a request
Reading a Pathology Report
Administering medication The metabolism of Prescription Chart

UNIT 6 Doing a medication check medication
Medications Working as part of a team
page 46 Checking medication orders for
accuracy
Explaining drug interactions
Checking the ‘ five rights’ of
medication administration
Reading a Prescription Chart
4 Contents
Skills Medical focus Charting and
documentation
Reviewing IV infusions IV cannulas IV Prescription Chart
Passing on instructions to Fluid Balance Chart
Intravenous colleagues
infusions Assessing IV cannulas
page 54 Telephone skills: taking a message
about patient care
Checking IV orders
Charting fluid intake and output
i
' { .
-
Ifr iiit 4?
Doing pre - operative checks Blood circulation Pre- operative Checklist
UNIT 8 Giving pre operative patient
Pre -operative \ i education
patient Preparing a patient for surgery
assessment Allaying anxiety in a patient
page 62 Using Pre- operative Checklists
Pain receptors Universal Pain

Giving a post -operative handover
Assessment Tool
Checking a post-operative patient
-
Post operative on the ward
patient Explaining post - operative pain
assessment management
page 70 Dealing with aggressive behaviour

Using pain assessment tools
Cerebrovascular accidents Telephone Referral Form

Attending the ward team meeting
Kat7 ADL Index
Telephone skills: referring a
patient Discharge Plan
Discharge
planning Explaining the effects of a stroke
page 78 Using patient discharge planning
forms
Role plays and additional material page 86

Audioscript page 94
Answer key page 110
Acknowledgements page 120
Contents 5
UNIT 1
• Taking a patient history
• Using active listening
strategies
• Explaining how the heart works
• Putting a patient at ease
• Giving a nursing handover
• Charting blood pressure and
l a i n pairs, look at the picture and discuss the following questions.

1 What do you think the nurse is doing?
2 What information might you need to collect in this situation ?
3 Why might this information be important ?
4 What strategies have you found useful when greeting a
patient for the first time?
b l.l Shona , the Ward Nurse, is admitting Mrs Chad. Listen

to the conversation and answer the following questions.
1 Is Mrs Chad mobile?
2 Has she been waiting long?
3 Which hospital unit is she being admitted to?
C !.! Listen again and put the following sentences in the correct order.
How are you today?
I’d like to ask you a few questions, if it’s all right with you ?
Not too bad, thank you.
.
Good morning Shona.
Yes, of course. That’s fine.
CD Good morning, Mrs Chad. My name’s Shona. I ’ll be admitting you to the
ward today.
d u Listen to the rest of the conversation between Shona and Mrs Chad
and answer the following questions.
1 Why is Mrs Chad in hospital?
2 What happened to her last year ?
3 Does she have any allergies?
4 Does she have a relative who can be contacted during an emergency?
e u Listen again and match the questions ( 1 - 7) to the answers (a-g) .
1 Can you tell me your full name, please? x a Not that I know of.
2 Can you tell me why you're here today ? \ b No, I'm very lucky.I never have,
3 Have you had any serious illnesses in ' c .
It's my son, Jeremy Jeremy Chad,
the past? d Yes, I had a mild heart attack last
4 Have you ever had any operations? year.
5 Now, are you taking any medications at the e Well,I've got high blood pressure, and
moment? I'm here for some tests,
6 Do you have any allergies to any
f Yes, my doctor put me on some blood
medications? pressure tablets after my heart attack,
7 Can you tell me the name of your next
of kin? g Yes, it's Doreen Mary Chad.
f In pairs, take turns to ask and answer the questions from Exercise le,
using the following information and your own name and next of kin.
• I had my appendix out when I was fourteen.
• I take aspirin every day for my arthritis.
• I’m here for a chest X - ray.
• I had pneumonia two years ago.
• I'm allergic to nuts.
g In pairs, discuss how you might change your approach for the following
patients.
1 An elderly patient who uses a walking aid
2 A young patient
3 A patient who has been waiting a long time
Communication focus: using active listening strategies

2 3 In pairs, discuss the following questions.
1 What are active listening strategies?
2 Why do you think they are important ?
b Complete the following active listening strategies using the words and
phrases in the box .
eye contact mm nodding your head hm I see
1 Using expressions such as Really ? , Is that right?, and Yes or

No .
2 Making ‘listening noises’ like and shows that
you are interested in what the speaker is saying.
3 Leaning towards the other person and also shows interest.
4 Smiling while maintaining puts a patient at ease.
’s
C li Shona uses several active listening strategies whilst taking Mrs Chad
details. Listen again and find examples in the audioscript on page 94.
d In pairs, practise taking patient details. Student A , you are Shona; Student
B, you are Mrs Chad. Remember to use active listening strategies. Swap
roles and practise again.
Unit 1 Patient admissions 7

e In pairs, prepare nurse- patient interviews. Student A, you are the nurse;
look at the Patient Admission Form and think about the questions you will
ask to complete it. Student B , you are the patient; read the patient details
on page 86 . Swap roles and practise again using the patient details on
page 93.
THE ALEXANDRA HOSPITAL

X
p (Patient Identification Label)
PATIENT ADMISSION FORM
Patient details
Full name
DOB
Reason for admission
Past medical history
Past surgical history
Medication
Allergies
Next of kin
..v.y.v. . .-.
v v v *'
*
TO '
itiiir:
Share your knowledge

In small groups, discuss the following questions and then feed back
your group’s ideas to the class.
• Is the process for taking a patient history the same in your country?
• How has the introduction of privacy laws and Nursing Informatics
changed the way patient information is recorded and used ?
• What do you know about Electronic Patient Records (EPR) ?
• Are you familiar with coding for improved patient identification?
HBI
8 Unit 1 Patient admissions

Medical focus: the heart
Explaining how the heart works
3 a In pairs, answer the following questions.
1 What is the cardiac cycle?
2 What does the heart do during a heartbeat ?
3 What symptoms does a person have if there is not enough blood flow
through the heart ?
4 Why might nurses in the Cardiac Unit need to explain the cardiac cycle to
their patients?
b Read the patient information leaflet. In pairs, discuss what the following
parts of the heart do.
the atria the valves the ventricles the pulmonary vein

the pulmonary artery the aorta
How does your heart work?

The blood enters the right atrium, one
of the upper receiving chambers of the
heart . Blood is pumped through the
tricuspid valve into the right ventricle.
- i
i aorta C
' >5
The right and left ventricles are larger
than the right and left atria because they
are responsible for the pumping action
of the heart . The right ventricle pumps
L i ; raw
y artery
ml
de- oxygenated blood away from the heart : j
-
I Vi
through the T- shaped pulmonary artery. left
By the time blood arrives in the lungs the \ atrium
body has taken out most of the oxygen right
and made use of it for tissue function. atrium
In a healthy heart, the blood flows left
tricuspid ventricle >
efficiently through the heart to the lungs,
valve
which re -oxygenate the blood and return
it to the heart through the pulmonary
right ventricle
vein. Oxygenated blood enters the heart
through the left atrium and is pumped
to the left ventricle. The left ventricle is
encased in thicker cardiac muscle than
the right side because it has to pump
oxygenated blood around the entire
body via the aorta, the largest artery
of the body. The cardiac cycle relies on the efficiency of the four valves between the atria, the
ventricles and the pulmonary blood vessels. These valves open to let in sufficient blood flow to
fill each heart chamber and then shut to prevent the backflow of blood. Irregularities in blood
flow because of blockages in the blood vessels can lead to heart disease.
C In pairs, practise explaining how the heart functions. Student A , you are a
nurse; Student B , you are a patient. Swap roles and practise again.

Communication focus: putting a patient at ease
Before discussing important lifestyle changes with a patient, it is important
to put the patient at ease. Sensitive topics can be broached more easily if the
patient feels relaxed and comfortable.
4 a u Listen to a conversation between a Nurse Educator, Susanna , and her

patient , Mr Hockings. What is the topic of their discussion and why is it
important?
b Susanna uses several informal expressions to create a friendly and relaxed

relationship with the patient. Match the expressions from the dialogue
( 1-7 ) to their meanings (a-g).
1 have a chat a monitor

^
2 a bit of a shock b I'm going to sit down
3 a bit flushed c ruddy/red complexion
A watch for d take notice of
5 I'll just grab a chair e discuss
6 fired up f enthusiastic
7 keep an eye on g unpleasant surprise
C Complete the strategies for putting a patient at ease ( 1- 4 ) using the words
in the box . Then match them to the rationales (a-d).
judgemental rapport positive same level
1 Sit at the as the patient . a This encourages patients in their attempts

at learning new information .
2 Make responses whilst b This shows respect for the patient's right
nodding your head . to make decisions about healthcare.
3 Don't make comments . c This can lighten the atmosphere and help
patients relax.
4 Use humour to establish a good d This helps patients feel that you are
with your patient. interested in talking to them rather than
over them.
d 1.3 Listen again and find examples of the strategies in Exercise 4c in the
audioscript on page 94 .
e In pairs, practise putting a patient at ease. Student A , you are Susanna;

Student B , you are Mr Hockings. Remember to use active listening
strategies. Swap roles and practise again.

• What strategies do you use for putting a patient at ease ?
• What difficulties have you encountered with anxious patients?
• What role does cultural sensitivity play when putting a patient at ease?

Charting and documentation:
a nursing handover
Healthcare professionals write entries about patients in their care in the
Patient Record. The Patient Record documents patient care and , as such,
forms a permanent legal record of treatment . At the end of each nursing shift ,
the outgoing nurses give a verbal handover to nurses on the incoming shift.
The nurses on the incoming shift are briefed on changes in patient progress
and patient care. The handover is usually performed face-to -face but some
institutions use recorded handovers. The information which is reported during
the handover is gathered from the Patient Record , the Care Plan and any other
charts which document specific patient care.

1 What do you think are the features of a good handover ?
2 What information does not have to be repeated
in a handover ? Why not ?
3 What can happen if handovers do not communicate important
information
from one shift to another ?
b n Listen to Emily, a Ward Nurse, handing over a patient, Mrs Cho , and
answer the following questions.
1 What is her present medical problem ?
2 What is her past medical history ?
C
^
1
1.4 Listen again and mark the following statements True (T) or False (F) .
She does not manage her ADLs at home by herself.
2 She has been quite distressed.
3 Her BP at 10 am was 200 / 105 .
A Her pulse was 88 at 10 am.
5 The porter has been booked for tomorrow.
d Abbreviations are often used in both Patient Records and verbal handovers.
Some are only found in written documents. It is important to check which
abbreviations are approved at the hospital where you are working, as there
may be some variance.
Match the abbreviations ( 1- 14 ) to their meanings (a- n) .

1 BP a activities of daily living
2 P b four times a day
3 qds c Senior House Officer
4 MI d electrocardiogram
5 GTN e sublingual, or under the tongue
6 SH 0 f myocardial infarction, or heart attack
7 4° g blood pressure
8 c/o h complain of
9 si i observations
10 0, j four hourly, or every four hours; also 4/ 24
11 ECG k patient
12 ADLs l glyceryl trinitrate; also called nitrolingual
13 Pt m pulse
14 obs . n oxygen

e M Listen again and complete the following extract using the
abbreviations in Exercise 5 d.
Right, now Mrs Cho in bed number five. Mrs Cho was readmitted yesterday
because of uncontrolled hypertension. You’ll probably remember her from
last week . She went home but couldn’t manage her ( 1 ) ABU . by herself . Her
daughter had to come in every morning to give her a shower and help her
during the day. She's been quite distressed about it, according to her daughter.
She presented to the unit with uncontrolled hypertension , despite a change
in medication. She has a past history of ( 2) this year in June. Urn, this
morning she complained of chest pain . The ( 3 ) was called. Her
( 4) at the time - er, that was 10 am - was two ten over one oh five,
and her pulse was one hundred. She had an (5) _ done and was given
( 6) sublingually. We gave her some ( 7) _ via the mask and she
seemed to settle. She’s in for cardiac catheterisation tomorrow to assess the
extent of the damage to her heart . I’ve booked the porter already. Strict four
hourly BP and pulse and report any chest pain immediately, of course. She’s
had no chest pain this shift .
f A Patient Record contains entries from every member of the patient's team. As a
nurse, you must read all entries in order to plan patient care efficiently .
Another patient, Mrs Smits, is handed over. Use information from the
Patient Record to complete what was said.
THE ALEXANDRA HOSPITAL JW U/ N: 732910

Surname: Smits
Given names: Livia
PATIENT RECORD DOB: 10.12.31 Sex: Female
DATE & TIME Add signature, printed name, staff category, date and time to all entries
MAKE ALL NOTES CONCISE AND RELEVANT
Leave no gaps between entries
/ Vs Smits do chest pain at ZZOOhrs. SHO

18.52008 '
ZZlOhrs. informed. 0- administered via a mask . 23P 220 / 100
P 1 Z0 at ZZ.00 hrs. SHO ordered ECO, attended
by nursing staff. GTN si administered at 2205 hrs,
chest pain relieved within Z minutes .
J Keene CRN ) KEENE.
Mrs Smits ( 1 ) o-P chest pain at ( 2) .

The (3) was informed . (4) was
administered via a mask . Her blood pressure was (5 )
and her (6) was ( 7 ) at
(8) . The (9) ordered an
( 10) ., which was done by nursing staff. GTN
( ID _ was given with good effect. The chest pain was
relieved within a couple of minutes.

g 1.5 Listen to Nick handing over Mrs Smits and check your answers. In
pairs, practise the handover using only the written Patient Record .
h In pairs, practise giving a handover using the Patient Record . Student A ,

look at the record on page 86; Student B, look at the record on page 93 .
Charting blood pressure and pulse

Mrs Small has been admitted with hypertension, which has been poorly
managed at home. Her doctor decides to review the medication she is taking
to control her high blood pressure. For the first day after admission, her blood
pressure and pulse will be observed regularly . The admitting doctor has placed
her on four hourly observations of blood pressure and pulse.
6 a in pairs, look at the chart on page 86 and discuss the following questions.
1 Are you familiar with this type of chart ?
2 What other styles of Observations Chart are you familiar with ?
3 Who has access to the chart ?
4 Who is responsible for completing the chart ?
b 1.6 Jenny, the Ward Nurse, is handing over Mrs Small to the afternoon
shift. Listen to the conversation and answer the following questions.
1 How long will Mrs Small be in hospital for ?
2 Why did Dr Fielding come to see her ?
3 What did Jenny do just before handover ?
c l.6 Some of the information in the Obs. Chart on page 86 is incorrect .

Listen again and correct any mistakes.
d Blood pressure readings are spoken as the first number on or over the
second. For example, 90/ 60 is ninety over sixty or ninety on sixty . How
would you say the following blood pressure readings?
1 110 / 70 3 142/ 99
2 150 / 90 4 86 / 40
e Look at Mrs Small’s handover in the audioscript on page 94 and find

phrases describing changes in her pulse or blood pressure readings. What
other phrases could you use? Add them to the table.
t i
increase stabilise decrease
f In pairs, practise handing over Mrs Small. Student A , you are Jenny;
Student B , you are a nurse on the afternoon shift . Use the Obs. Chart on
page 86 , the audioscript on page 94 and the phrases in Exercise 6 e. Swap
roles and practise again .

UNIT 2
• Educating patients about
asthma management
• Giving instructions effectively
\
• Using a nebuliser
• Talking to a child about asthma
• Putting a young patient at ease
• Describing respiration
* Charting respiratory rates
management
1 a In pairs, look at the picture and discuss the following
questions.
1 What do you think this equipment is used for ?
2 Have you used this equipment before ?
b ll Eleanor is an Asthma Clinic Nurse. One of her

roles is to educate patients in their asthma management. Listen to
a conversation with a patient , Mrs Drake , and answer the following
questions.
1 How does Mrs Drake feel ?
2 Why is Eleanor teaching her to use a peak flow meter ?
3 At what time of day should she take the reading?
4 What three things does she have to remember ?
C M Listen again and complete the following extracts.

1 Eleanor: ... a peak flow meter today, if I go
through it with you now?
2 Eleanor: Now, to use this peak flow meter at the
same time every day.
3 Eleanor: Another thing - record your readings
in this Daily Record Chart, please ?
14 Unit 2 Respiratory problems

d You are going to listen to Eleanor giving instructions on using the peak flow
meter. Before you listen, put the following sentences in the correct order.
The last thing to remember is to record the highest of the three readings on
your Daily Record Chart.
After that, I want you to blow into the peak flow meter two more times.
Next, blow as hard and as fast as you can with one breath.
11 Right, first of all, just move the red indicator to the bottom of the numbered
scale, like this.
Now, stand up. Take a deep breath and try to fill your lungs as much as you
can.
Make a note of the final position of the marker.
0
^ 2.2 Listen and check your answers.
f Find the instructional language in the audioscript on page 95 . What do you

notice about the verb forms?
Communication focus: giving instructions effectively

2 a In pairs, discuss the following questions.
• How
Do you know any techniques for giving instructions effectively?
• can you make sure your instructions are effective?
b Complete the strategies for giving instructions effectively ( 1 — 8) using the

words and phrases in the box .
at the same level demonstrate I' m going to teach you how to ...
understood repeat smiling firstly, secondly That's right fingers
1 Put the listener at ease by using positive non-verbal communication such as

svnl)lv\g
2 Sit or stand as the patient.
3 Give encouragement by making remarks such as yes ,.
good , Well done , etc .
4 State the purpose of the communication before giving instructions,
to prepare the listener for important information; for example:
5 Use a level of language which can be _ by the listener.

6 Give instructions in steps, for example .
, etc You could
count the steps on your to make sure your patient
understands you.
7 instructions on the relevant piece of equipment,
8 instructions and allow the listener to ask questions.
C lIS 2.2 Which of the strategies does Eleanor use with Mrs Drake? Listen
again and find examples in the audioscript on page 95 .
d In pairs, practise giving instructions on how to use the peak flow meter.
Student A , you are Eleanor; Student B, you are Mrs Drake. Remember
to include strategies for giving instructions effectively. Swap roles and
practise again.
Unit 2 Respiratory problems 15

Using a nebuliser
1 What is your experience of asthma management ?
2 What kind of asthma treatment is available?
b 2.3 Some asthma medication is delivered to the patient using specialised
equipment . Mr Dwyer’s treatment plan for his asthma management is
being changed. Listen to the Ward Nurse, Melanie, instructing Mr Dwyer
on how to use a nebuliser for the first time and put the following steps in
the correct order.
Breathe in the mist
Turn on the oxygen
Put on the mask
Put in the medication
Connect to the oxygen
C Match the beginnings ( 1 - 5 ) to the endings (a-e ) to complete Melanie ’s

instructions.
1 First of all, a put on the mask and tighten the elastic straps so that it fits snugly
2 Now, around the head.
b inhale the mist until it's finished,
3 Next,
c fill the chamber of the nebuliser ...
4 After that, d turn on the oxygen so the liquid medication turns into a fine mist,
5 Finally, e attach the tubing to the oxygen outlet on the wall.
d u How does Melanie give instructions effectively? Listen again and find
examples in the audioscript on page 95 .
G In pairs, practise giving instructions on how to use a nebuliser. Student

A , you are Melanie; Student B , you are Mr Dwyer. Remember to include
strategies for giving instructions effectively. Swap roles and practise again.

• What techniques do you find most useful when giving instructions?
• What techniques are not helpful when giving instructions?
• Have you ever encountered problems when giving instructions to a
patient?

I Medical focus: the respiratory system
Talking to a child about asthma
Tim, a Charge Nurse on the Paediatric Respiratory Ward, is describing the
normal flow of air into the lungs to an 8 - year -old patient, Susie. She has been
admitted after having her first serious asthma attach and needs education
about managing her condition .
4 a
^ 2.4 Listen to the conversation and label the parts of the respiratory
system using the words in the box .
alveoli throat or pharynx windpipe or trachea oral cavity

voice box or larynx pleural membrane epiglottis intercostal space bronchus
1 ctfiviW
6 f kv- Q <?if /pUgnvyn

*
3 7
4 8
CL
5 0/ a. 9
10
0
Q
0 *
b In pairs, look at the pictures of a healthy airway and an

asthmatic airway and discuss the following questions.
1 What differences do you notice between the two
airways?
2 How can you tell if someone is having an asthma
attack ?
Healthy airways Asthmatic airways
C 2.5 Listen to the rest of Tim and Susie ’s conversation
and write healthy (H) and asthmatic (A) for the
following sentences.
1 a A lining of healthy tissue which is not swollen,
b A thickened lining of tissue which is often inflamed.
2 a The contracting muscle layer makes breathing more difficult.
b The contracting muscle layer helps conduct air into and out of the
alveoli.
3 a Gas exchange occurs in the tiny air sacs called alveoli.
b The exchange of carbon dioxide and oxygen is hindered by narrowed
airways.
4 a Wheezing sounds indicate respiratory effort,
b Respiration is quiet and easy.
What do you notice
d 2.5 Listen again and complete the following flowchart .
^
about the verb forms in 1- 4?
Healthy airways Asthmatic airways

I Tissue (1)
Tissue is not thick
I Airway ( 4)
Muscle layer contracts
\ Chest muscles ( 5 )
Air ( 2 ) into and out
of the alveoli
I with 02
Difficult (6)
C0? (3)
Communication focus: putting a young patient at ease

What strategies can you use to put a young patient at ease?
• ful?
Have you used any of these strategies yourself ? Were they success
•
ease ( 1-8) using the
b Complete the strategies for putting a young patient at
words in the box.
simple small talk encouragement diagrams explain
cheerful appeal level decision making -
frgOV , for example asking about the child’s hobbies or interests.
1 Use
2 Stand or sit at the same as the child.
3 Use , clear sentence s and check for understanding.
4 Use pictures or to illustrate what you are saying.
5 Involve the child in , for example: Let’s call this one healthy
airways - does that sound like a good idea?
6 Give
7 Use short, simple phrases which to children , for example: the
little flap .
8 Use a tone of voice.
9 medical terminology in simple terms.
2.4 & 2.5 Which of the strategies does Tim use with Susie?
Listen to the
C
again and find example s in the audiosc ript on page 95 .
whole conversation
again.
d In pairs, practise the dialogue. Swap roles and practise
asthma
Natalie, a 10 - year - old asthmatic, has been admitted after severe
a
e
has suffered . Candy , the Nurse
attack . This is the first asthma attack she
to the airways
Educator in the Respiratory Unit, needs to explain what happens
when Natalie has an asthma attack .
In pairs, use the diagram of healthy airways and asthma

tic airways on page
in an asthma attack . Student A , you are Candy ;
17 to explain what happens
you are Natalie. Remem ber to use strategie s for putting a young
Student B,
patient at ease. Swap roles and practise again .

Describing respiration
6 a Match the medical terms ( 1 -7) to their meanings (a-g).
1 inspiration —
2 inspiratory rate
a at four litres per minute
b the rate at which a person breathes out (expressed as breaths per minute)
3 respirations c breaths - that is, movement of air in and out of the lungs
4 respiratory rate d the rate at which a person breathes in ( expressed as breaths per minute)
5 expiration V e breathing in
6 expiratory rate f the rate at which a person breathes in and out ( expressed as breaths per minute)
7 @ 4L/min g breathing out
b Underline the stressed syllable in words 1 -6.
C In pairs, take turns to say a word and ask your partner to define it, or give
a definition and ask for the word.
d
^ 2.6 Listen to four extracts from conversations on a ward and answer the
following questions. Pay attention to the pronounciation of the words in
Exercise 6a.
1 Why are Mr Frank ’s family going to stay with him tonight ?
2 How is Judy managing her pain?
3 How was oxygen administered to Mr Walker ?
4 What caused Mr Sims’ tachypnoea?
e In pairs, look at Mrs Oondahi’s Nursing Notes and ask and answer
questions using the prompt cards. Student A, turn to page 86; Student B,
turn to page 93.
DATE & TIME Add signature,printed name, staff category, date and time to all entries
Z 3.09 NURSING AVs Oondahi appears to be breathing comfortably at the time of the
Zl .OOhrs report and is quite settled. RR is 16, not laboured. 0 , @ 3 L / min via nasal cannulae.
Rt lying on two pillows. Rain relieved by morphine via continuous s.c infusion.
Ram rated at I / 10 at Z030hrs . Ratient states she is comfortable. Famity in
attendance all shift . Husband and children will stay overnight with her.
T>. SUpso ( RN ) SIMRSON
*

• Are family members / partners permitted to stay with a dying patient in
hospital in your country ?
• What are the benefits of allowing this arrangement?
• Are there any difficulties with this arrangement ?
• Why is it important to be culturally sensitive in this type of situation?

Charting and documentation: respiratory rates
7 a Mr Wilmott , an 86- year- old who lives alone, has been admitted to hospital
for treatment . In pairs, look at his record and discuss the following
questions.
1 What is Mr Wilmott’s diagnosis?
2 What is the treatment ?
3 What is happening in the morning?
4 What respiratory assessment has he started doing himself ?
THE ALEXANDRA HOSPITAL f/ U /N: 593712

Surname: Wilmott
Given names: Ronald
PATIENT RECORD DOB: 15.9.1922 Sex: Male
1100 New admission to the ward with a diagnosis of

WQ3 /0&
poorly managed asthma. 'Recent URTI treated
with antibiotics. Rt still c / o 503. RR elevated.
For CXR and review by Respiratory Team in
am. Started on p / f readings and Rt ed. regarding
asthma.
. Xoelane ( RN ) VFLANFY
^
b Match the abbreviations from the Patient Record ( 1-6) to their meanings
(a- f).
1 URTI a respiratory rate

2 SOB b peak flow; the most air which is expired
3 RR c chest X- ray
4 CXR d patient education
5 p/ f e upper respiratory tract infection
6 Pted. f shortness of breath; difficulty breathing ( dyspnoea)
C In pairs, take turns to ask for the meaning of an abbreviation.
d w Mrs Castle is a 56- year-old with a past history of respiratory problems

relating to chronic asthma . Listen to a conversation between two Ward
Nurses, Mandy and Rosa , and answer the following questions.
1 How often is Mrs Castle having her respiratory rate checked?
2 How much oxygen was she having when she returned from her operation ?
3 Why was she given oxygen?
4 How long will Mandy be away ?
e 2.7 Some of the information on Mrs Castle’s Obs. Chart on page 87 is

incorrect. Listen again and correct any mistakes.

! f Match the medical terms ( 1- 5 ) to their meanings (a- e).
1 apnoea
2 bradypnoea
a the patient has laboured breathing or difficulty breathing
b the patient is not breathing at all
c the respiratory rate is rapid; it has increased to between 20
3 eupnoea
and 30 breaths per minute
d the patient's breathing is slow rate; the respiratory rate is
4 tachypnoea
less than 12 breaths per minute
e the patient is breathing a normal respiratory rate
5 dyspnoea
- between 12 and 20 breaths per minute
g Underline the stressed syllable in words 1 - 5.
h In pairs, answer the following questions.

1 The word element - pnoeo (US - pnea} means breathing . Is the p a silent
letter in all words which are formed using this word element ?
2 If not , which word(s) from Exercise 6f do not have a silent p?
i Read the entry in Mrs Castle’s Patient Record made by Dr Smith , the
Senior House Officer, and answer the following questions.
1 What do the abbreviations AE and FBC stand for?
2 Does Mrs Castle have a high temperature?
3 Are her respirations fast or slow ?
4 When will she have the blood test done ?
5 Was she taking aspirin before ?
THE ALEXANDRA HOSPITAL P U/N: 593712

Surname: Castle
Given names: Rebecca
PATIENT RECORD DOB: 15.9.1922 Sex: Female
W02/09 Surgical SHO Smith

Pt is conscious
tachypnoeic 36 PP
afebrile
lung auscultation
no ÂE bilat basely
crackles or wheezes
Plan CXP in am
.
FBC today please

aspirin to be restarted next week
F. H. Smith SMITH (bleeper 8516)
j In pairs, take turns to ask and answer more questions about Mrs Castle ’s
Patient Record. Student A , you are handing over Mrs Castle to Student B.
Swap roles and practise again.

UNIT 3
• Discussing wound management
• Describing
Asking for advice
• wounds
• Taking part Continuous
in
Professional Development
• Chart
Using a Wound Assessment
Discussing wound management

1 What is your experience of wound management ?
2 What treatments are you familiar with?
3 What are some of the complications that can occur
with wound healing?
b In pairs, look at the picture and discuss the following questions.

1 What is the nurse doing?
2 Why is she wearing gloves ?
3 What wound closures are you familiar with?
C Clinical Nurse Specialists act as consultants in most large hospitals. They often
work as part of a Health Team and assist ward staff when specialised knowledge is
required. Some of the areas a Clinical Nurse Specialist will offer advice in are wound
management , stoma care and renal dialysis.
3.1 Listen to a conversation between Sophie, a Clinical Nurse Specialist ,

and AM, a Ward Nurse, and answer the following questions.
1 Why has Ali asked Sophie to come to the ward ?
2 What kind of wound does Mr Jones have ?
3 How long has he been in hospital this admission ?
22 Unit 3 Wound care

d Put the following sentences in the correct order.
He had a Doppler test done last week .
We sent a wound swab off , and we just got the results yesterday.
[D Mr Jones is a 68-year -old smoker with a long history of PVD.
He’s started on some IV antibiotics.
Two weeks ago he was admitted to this ward to have an assessment of his
circulation and to monitor his wound management.
He developed a venous ulcer on his right ankle after he tripped on some
stairs ...
His local doctor had a look at it and asked the District Nurses to come
and dress the wound at home.
e
f
^ 3.1 Listen again and check your answers.
Match the medical terms and abbreviations ( 1 - 7 ) to their meanings (a-g).

1 CNS a microbes
b ultrasound device which measures blood flow through
2 PVD \
arteries and veins
3 Doppler c have episodes of pyrexia
4 bugs d antibiotics which are given through a vein
5 spike a temperature e Vacuum Assisted Closure; also pronounced vac
6 IV ABs f Clinical Nurse Specialist
7 VAC g Peripheral Vascular Disease
g Listen to a conversation between Sophie, Ali and Mr Jones and answer

the following questions.
1 Why is Mr Jones ’s ulcer being reassessed ?
2 What type of dressing are they going to use?
3 Why has this type of dressing been suggested?
Communication focus: asking for advice

2 3 Match the beginnings ( 1 - 5) to the endings (a- e) to complete the
questions.
1 Would you mind a that we change to?

2 What would you recommend b use?
3 What do you think c giving me some advice on his wound care management?
4 What do you suggest we d to try that instead of the dressing they're using now?
5 Do you think it's a good idea e I should do with this ulcer ?
b Match the sentences in Exercise 2 a to the most likely responses.

1
Well, I think the first thing to do is to reassess the wound.
2
I’d like to use a VAC dressing on this wound.
3
No, not at all. That’s what I’m here for.
4
Let me have a look at the wound and we’ll see what the best option is.
5
Yes. I think it’ll help the wound heal faster.
Unit 3 Wound care 23

C In pairs, practise asking for and giving advice on the treatment of Mr Jones’
ulcer. Student A, you are the Ward Nurse; Student B, you are the wound
management Clinical Nurse Specialist. Swap roles and practise again.

• Do you have wound management Clinical Nurse Specialists in your
country?
• If not , how do you get advice on managing chronic wounds?
Medical focus: wound bed preparation

Describing wounds
The progress of wound treatment is monitored and recorded in a Clinical
Pathway or Integrated Care Pathway (ICP) document A specialised wound chart
describes the dimensions of the wound, the type of discharge from the wound
and the presence or absence of infection.
3 3 In pairs, look at the pictures of wounds (a-d) and discuss the following
questions.
1 How would you describe the wounds?
2 How would you manage them ?
a b
c d

b Match the medical terms ( 1 - 8) to their meanings (a- h).
1 necrosis
2 eschar
—- a
b
thick, dry, black necrotic tissue
drying out
3 desiccation cinflammation of the tissue under the skin, often caused by infection
4 inflammation da small piece of material which is used to take samples of body fluids
5 swab edead tissue which separates from healthy tissue after infection
6 slough fthe removal of dead tissue
7 debridement g swelling caused by infection
8 cellulitis h death of cells and living tissue
C Underline the stressed syllable in words 1 -8.
d In pairs, take turns to say a word and ask your partner to define it.
e Complete the following sentences using the words in the box and then match
the sentences to the photos in Exercise 3 a .
cellulitis slough eschar inflammation swab necrosis desiccation debridement
1 Mrs Ximenes has an area of v\ecvosis , or dead tissue, on her left lower
leg. There are blackened areas, or , on the upper wound. These
areas will be surgically debrided tomorrow.
photo
2 Mr Edwards has in the lower leg. The wound is showing signs
of drying out , or - there is quite a lot of skin flaking off his leg.
photo
3 The skin surrounding Mrs Heath’s leg wound is red and warm to the touch.
The is a sign of infection and was confirmed by a wound
sent to the Pathology lab three days ago.
photo
4 The yellowish , or dead fibrous tissue, on the inner part of
Birad’s wound will have to be softened before or removal of the
tissue, is possible,
photo
f In pairs, take turns to describe the wounds in Exercise 3 a .

1 Diabetic ulcers, also called neurotrophic ulcers, are usually found on
the balls of the feet at the points of maximum pressure. What sorts of
difficulties would the location of these ulcers cause ?
2 What advice would you give diabetics about footwear?
3 What may occur as the consequence of diabetic ulcers?
I

Taking part in Continuous Professional Development (CPD)
Continuous Professional Development is a major workplace focus for nurses
and is a requirement for continuing registration in some countries. It ensures
that nurses keep up -to -date with current trends in clinical practice, such as
Evidence- Based Practice (EBP) and risk management clinical governance.

• What is your experience of Continuous Professional Development ?
• Are you familiar with sharing your knowledge through feedback sessions on
the ward? If not, how do you share your knowledge with your colleagues?
b YOU are attending a CPD training session given by a wound

management Clinical Nurse Specialist , Mr John Simpkins, on wound bed
preparation. Listen and tick the medical terms you hear ( 1 -8).
1 0 well-vascularised a the transplantation of skin from another part of the body to a wound which
cannot heal on its own
2 0 viable b excessive softness caused by too much moisture

' c good blood circulation is achieved, and the tissues are supplied with oxygen and
3 0 necrotic tissue other nutrients
4 high bacterial load d long-term or ongoing
5 0 exudate e a high level of infection carried by the tissues
6 0 maceration f ooze or discharge from a wound
7 0 chronic g able to grow or survive
8 0 skin graft h dead tissue
C Match the medical terms above ( 1-8) to their meanings (a-h).
d In pairs, take turns to say a word and ask your partner to define it.
6 Listen again and complete the following handout using the words in
the box.
necrosis exudate dryness load balance inflammation stable base
SESSION HANDOUT
The aim of wound bed preparation is to prepare a (1) wound environment which
results in wound healing.
This is achieved by:
a) restoring a well- vascularised wound bed, or (2)
b) decreasing the high bacterial load by controlling (3) or infection
c) creating moisture (4) in the wound environment
The barriers to wound healing include:
a) the presence of (5) _ - in other words, dead tissue
b) high bacterial (6) _ , or a high level of infection carried by the tissues
c) imbalance of moisture levels: wounds with excessive (7) - that is, wounds
which are too moist - and wounds which have excessive (8) , or desiccation
will not heal properly

f lA Listen to the second part of the training session and complete the rest
of the handout using the words in the box .
dressings graft debridement infection viabte imbalance excessive reassess antibiotic
desiccation reduced optimal fluid chronic well-vascularised advanced surgical
What is TIME? TIME is an acronym for a framework which helps to identify barriers to healing in the wound bed and
identifies expected outcomes of treatment .
T I M E
Description Tissue is not Inflammation or Moisture Edge of the wound does
of the wound (1) viable . (5) (8) not heal.
I he tissues of the wound is present. (9) The wound becomes a
bed do not have sufficient The high bacterial load exudate causes (14)
blood supply to survive . prevents healing. maceration, or softening, wound.
of the wound edges.
(10)
or excessive dryness,
slows healing.
Clinical (2) Remove the infection and Hydrating (15)
action of necrotic tissue. reduce the high bacterial (11) the wound.
Often a load. which add moisture for Consider different
(3) Antimicrobial dressings dry wounds. management, e.g. skin
procedure. as well as Negative pressure (16) to
(6) dressings, e.g. VAC replace the damaged skin .
medication are used. dressings, which remove
excess
(12) in
macerated wounds.
Expected Wound bed is (7) The wound has an The edge of the wound
outcome (4) and inflammation around the (13) has (17)
has a good blood supply. wound. moisture balance. or healed .

• Do you follow the same process for wound bed preparation?
• What are the advantages of following the wound bed preparation
protocol?
• Have you ever had any experience with skin grafts? If so , what type ?
r/

Wound Assessment Chart
1 What is your experience of treating animal bites or wounds?
2 What complications can arise?
3 How can these complications be avoided?
b
^ 3.5 Cary Stephens has presented to Accident and Emergency with a
severe dog bite wound. Listen to a conversation between Gary and two
A& E nurses, Krisztina and Judy, and answer the following questions.
1 What kind of dog bites are a serious infection risk ?
2 How will Cary’s wound be treated?
C SJ The conversation contains several examples of asking for and giving

advice. Listen again and match the requests ( 1- 4) to the advice (a-d).
1 Krisztina, what do you suggest I dean a Sure ... I'd like you to keep the dressing dean and dry and come to
the wound with? Outpatients to have the dressing changed daily.
2 Can you give me some advice on b Yes, that'd be a good idea.
looking after this at home?
3 What should I do about the c It's best to flush it with lots of Normal Saline before you do the dressing.
antibiotics? d You'll be prescribed some antibiotics by the doctor a bit later. You'll get a
4 ShouldIget a medical certificate? script which you can take to the hospital pharmacy to be filled.
d
^ 3.6 Jennifer, the Ward Nurse, is handing over Cary Stephens to the
afternoon shift . Listen to the handover and put the following stages
described in the handover in the correct order.
Cary was started on IV antibiotics to clear up the infection in the wound.
He is in for a review by the Vascular Team on Monday.
The wound was surgically debrided this morning.
[0 Gary Stephens sustained some deep puncture wounds in his left calf after a
dog bite.
He was treated in A& E and discharged home.
Gary returned to the ward with an antimicrobial dressing which will be
re dressed tomorrow.
The wound was reassessed yesterday.
The wound became infected and he has returned to hospital.
e Match the medical terms ( 1 - 1 2 ) to their meanings (a — I).

1 granulated a with yellowish fluid or blood serum
2 sloughy b adding moisture to something
3 macerated c a dressing which does not stick to the wound
4 inflamed d contains dead tissue which falls off a wound during an infection
5 serous e the dressing is sealed and cannot be lifted off for viewing
6 haemoserous f full of pus, a yellow or green discharge found in an infected wound
7 purulent g containing connective tissue found in healing wounds
8 odour h something which treats infective microorganisms
9 non -adhesive dressing ( NAD) i softened because of excess moisture
10 antimicrobial j yellowish fluid tinged with red blood cells
11 hydrating k red and swollen because of infection
12 intact wound l smell (usually unpleasant)

f Underline the stressed syllable in words 1 -12.
g In pairs, take turns to say a word and ask your partner to define it.
h Look at the Wound Assessment Chart. In small groups, discuss your

experience if you have used a chart like this before.
THE ALEXANDRA HOSPITAL
U/N: 376442
WOUND ASSESSMENT CHART
Surname: Stephens
Given names: Gary
Ward
DOB: 5.01.1974 Sex: Male
Consultant H. P V 0 WV \
WOUND ASSESSMENT FORM

Date 8/2/2008
Name Gary Stephens
Wound site Lcalf
Wound description granulated sloughy necrotic infected
Frequency of dressing bd tds daily 3 rd daily
Antibiotics no yes oral IV
Surrounding skin healthy dry macerated inflamed
Exudate nil small amt moderate heavy
Exudate - type N/ A serous haemoserous purulent
Odour present yes no
Debridement nil surgical mechanical chemical
( wet to dry dressings)
Dressing products non-adhesive dressing (NAD)
antimicrobial hydrating
Wound closure sutures clips open wound
Comments For review by Vascular Team on Mon
Wound intact - next dressing in two days
1 Find abbreviations in the Wound Assessment Chart with the following

meanings.
1 not applicable
2 three times a day
3 twice a day
4 left
5 intravenous
6 amount
j ifi Listen again to the handover of Gary Stephens and underline the
information you hear about his wound in the Wound Assessment Chart .
k In pairs, practise handing over Gary Stephens. Student A, you are
Jennifer; Student B, you are a nurse on the next shift. You can change the
description of the wound using vocabulary from Exercise 5 e. Swap roles
and practise again.

UNIT 4
• Discussing diabetes
management
• Making empathetic responses
• Giving advice sensitively
• Explaining hypoglycaemia and
diabetes
• Using a Diabetic Chart
I Discussing diabetes management

1 Is diabetes a serious problem in your country ?
2 What are your experiences of dealing with patients with
diabetes?
3 What do you think is happening in the picture?
b il Listen to a conversation between Mrs Kim, a diabetic patient , and Susan ,

the Diabetic Clinic Nurse, and answer the following questions.
1 What is the main purpose of Mrs Kim’s visit?
2 Who looked after her before she started at the Diabetic Clinic?
3 Why was she in hospital last week ?
C ll Listen again and mark the following statements True (T) or False (F) .
1 The Diabetic Clinic referred Mrs Kim to the hospital.
2 She no longer requires a Personal Care Plan.
3 The Primary Care Team is a network of the Diabetic Clinic, the local doctor and
the patient .
d Look at the rest of the conversation and complete Susan s questions.
Susan: ( 1) do you see your local doctor ?

Mrs Kim: I see her at least once a month for a checkup.
Susan: ( 2) do you check your BSLs, your blood sugar levels?
Mrs Kim: At the moment I check before meals and just before I go to bed.
Susan: Do you find it easy to use the glucometer ?
Mrs Kim: It's easy now. I can manage it quite well. My GP showed me how to
use it.
Susan: That’s good. I know what you mean; they are a bit difficult at first.
(5 ) do you have a urine test to check your kidney function?
30 Unit 4 Diabetes care

Mrs Kim : Once a year. I have it all done at once. I have the urine test, the eye
exam to check for retinal damage and my feet examined for nerve or
circulation problems. I did have some eye problems a while back and
my feet have been bothering me lately.
Susan: Oh, that’s a pity. Unfortunately, diabetes management isn’t just about
sugar control. There are quite a few things which need to be checked
as well. (4) have any hypos ? I mean, any hypoglycaemic
attacks?
Mrs Kim: Only occasionally. It usually happens if I skip too many meals.
Susan: Mm , it is very important to eat on time. (5) go to the
podiatrist to have your nails cut ?
.
Mrs Kim: Yes I do now. I used to try to do it myself but I got a nasty infection
once.
Susan: Oh, that’s not so good. I’m glad you go to the podiatrist now.
e In pairs, use these prompts to ask and answer questions between a nurse and
a diabetic patient. Swap roles and practise again.
• use a glucometer • have your feet checked
• eye examination • check cholesterol level
• check weight • have insulin injections
• exercise • skip meals
Communication focus: making empathetic responses

Making empathetic responses encourages open communication and indicates
emotional support by the listener. A rising then falling intonation is often used with
expressions indicating understanding and support ; for example: Oh dear /
Oh, that’s not good / I’m sorry to hear that / Mm.
2 d Look at the conversations between Mrs Kim and Susan in Exercise 1 d and the
audioscript on page 97 and find examples of Susan’s empathetic reponses.
b In pairs, practise giving empathetic responses. Use the questions from

Exercise 1 d and the prompts from Exercise 1 e. Swap roles and practise again.
Communication focus: giving advice sensitively

Mr Harry Williams, a 68- year -old insulin-dependent diabetic, has lived on his own
since his wife died five years ago. He is overweight and rarely does any exercise.
He used to like walking along the beach with his wife but hardly ever goes to the
beach now. He has become very careless about eating regular meals and, as a
result, his blood sugar levels are not stable. He used to have one or two glasses
of beer every night but recently his intake has increased. He also smokes about
two packets of cigarettes a week . Mr Williams has come to the Diabetic Clinic to
discuss lifestyle and nutritional changes.

1 What simple but significant changes should Mr Williams make to his lifestyle?
2 What is your experience of persuading elderly patients to change their lifestyle?
3 What strategies have you found to be the most successful?
Unit 4 Diabetes care 31

b
^ 4.2 Listen to a conversation between Mr Williams and Marta , the Ward Nurse,
and see how many of your ideas about lifestyle changes are mentioned.
C
^
1
42 Listen again and complete the following sentences.
You 51 make some major lifestyle
changes if you’re going to avoid nasty complications of diabetes.
2 You reduce your intake of saturated fats.
3 make sure you include carbohydrates in each
meal.
4 You really keep a close eye on your weight.
5 It would be a to get back to walking along the
beach again.
6 You keep a close eye on your alcohol intake because it can affect
your insulin dose.
7 ... it is stop smoking if you want to avoid
circulation problems.
8 You speak to your doctor about
some nicotine patches.
d In pairs, discuss the following questions.

• What strategies have you used to give advice sensitively ?
• What successes have you had?
• Why might patients reject your advice ?
6 Marta uses several strategies for giving advice sensitively. Match the
strategies ( 1 -7 ) to the expressions from the dialogue (a-g).
1 Justify advice a Could you try to include ...

2 Involve the patient in decisions N . b ...
it can be a problem for diabetics .. .
3 Acknowledge that something may be difficult to ]
achieve I c You must keep a close eye on ...
4 Be firm but non - aggressive d I know it must be difficult for you ...
5 Use impersonal statements, which are less
threatening
e ... it is important to stop smoking if you want to avoid ...
f It would be a good idea to get back to 'walking along the beach
6 Personalise the information
again.
7 Put the responsibility of the outcome on the
patient if the advice is not taken, in a firm but g You'll have to ... if you're going to avoid ...
supportive tone
f In pairs, practise asking for and giving advice on the following topics. Student
A , you are a nurse; Student B, you are a diabetic patient. Remember to use
the strategies for giving advice sensitively. Swap roles and practise again.
• coffee
weight control • smoking • alcohol
• • stress • cholesterol level
g In pairs, prepare nurse-patient interviews. Student A , you are the patient;

read your profile on page 87 and be ready to answer the nurse’s questions.
Student B , you are the nurse; read the patient profile on page 87 . Ask
questions about lifestyle and give advice on managing diabetes. Swap roles,
using the patient profile on page 93 .

Medical focus: the pancreas
4 3 Read the information leaflet and answer the following questions.
1 What is the exocrine function of the pancreas?
2 What is the endocrine role of the pancreas in diabetes management ?
3 What does insulin do to blood sugar levels?
4 What hormone has the opposite function to insulin ?
p The pancreas is a small L-shaped organ htv D .

: of all islet cells Alpha Ic
IICI sits against the duodenum behind make up almost twenty perceni ,
.
stomach. It is quite small, at around 15 release glucagon, which raises the level i
cm long. The pancreatic duct runs along the glucose in the blood. This is the opposif
middle of the pancreas and empties into the function to insulin. The level of glucos
duodenum. It supplies pancreatic enzymes, the blood is called either blood sugar lev
also called pancreatic juices, which aid in ( BSL) or blood glucose level (BGL). Insul
the digestion process. This is described as stimulates cells in the body to use or stor
the exocrine function of the pancreas, exo the glucose produced from the metabolism 0
meaning ‘out of ’. Pancreatic juices flow out carbohydrates in food. Glucose Is used ii
of the pancreas through the pancreatic duct, body as an energy source.
The poanci atic duct is joined
h» fhe common bile duct
Dytn/
before emptying into islet cells

i© duodenum. The
ancreas also has an ,7
bladder m
endocrine function,
aning ‘within’
lis is the release of
.. jrmone within the /
if bloodstream. There
are four main types w I
of hormone produced
in the hormone -
common
bile duct &
•
J
if producing cells of the

pancreas the islets
of Langerhans (islet pancreatic duct
feeds). One of the four
cell types - beta cells
- produce insulin. The duodenum
function of insulin is
lo lower the blood
f sugar level. Beta
cells make up almost
b In pairs, practise explaining the role of the pancreas to a patient who

has recently been diagnosed with diabetes. Student A , you are the nurse;
Student B , you are the patient. Swap roles and practise again.

b
^ 4.2 Listen to a conversation between Mr Williams and Marta , the Ward Nurse,
C
^
1
4.2 Listen again and complete the following sentences.
You !U make some major lifestyle
changes if you 're going to avoid nasty complications of diabetes.
meal.
beach again.
your insulin dose.

e Marta uses several strategies for giving advice sensitively. Match the
strategies ( 1 - 7 ) to the expressions from the dialogue (a-g).
1 Justify advice
2 Involve the patient in decisions
*
— a Could you try to include ...
..
b . it can be a problem for diabetics ...
3 Acknowledge that something may be difficult to
achieve
c You must keep a close eye on . . .
4 Be firm but non -aggressive d I know it must be difficult for you ...
threatening
f It would be a good idea to get back to walking along the beach
again.
supportive tone
A , you are a nurse; Student B , you are a diabetic patient. Remember to use
the strategies for giving advice sensitively. Swap roles and practise again.
• weight control • smoking • alcohol
• coffee • stress • cholesterol level

Student B, you are the nurse; read the patient profile on page 87 . Ask
using the patient profile on page 93.

b 1 Listen to a conversation between Mr Williams and Marta , the Ward Nurse,
C
^
1 You
4.2 Listen again and complete the following sentences.
'll Vo make some major lifestyle
changes if you’re going to avoid nasty complications of diabetes.
meal.
beach again.
your insulin dose.

6 Marta uses several strategies for giving advice sensitively. Match the
strategies ( 1 - 7 ) to the expressions from the dialogue (a-g).
1 Justify advice
2 Involve the patient in decisions
— a Could you try to include
b
...
... it can be a problem for diabetics ...
3 Acknowledge that something may be difficult to
c You must keep a close eye on ...
achieve
4 Be firm but non - aggressive d I know it must be difficult for you ...
threatening
f It would be a good idea to get back to walking along the beach
again.
supportive tone
A , you are a nurse; Student B, you are a diabetic patient. Remember to use
the strategies for giving advice sensitively. Swap roles and practise again .
• weight control • smoking • alcohol
• coffee • stress • cholesterol level
Student B , you are the nurse; read the patient profile on page 87. Ask
using the patient profile on page 93 .

Medical focus: the pancreas
4 3 Read the information leaflet and answer the following questions.
1 What is the exocrine function of the pancreas?
2 What is the endocrine role of the pancreas in diabetes management ?
3 What does insulin do to blood sugar levels?
4 What hormone has the opposite function to insulin?
i ne pancreas is a small L -shaped organ .

eighty percent of all islet cells Alpha cells
which sits against the duodenum behind make up almost twenty percent, and these ::' }
the stomach. It is quite small, at around 15 release glucagon, which raises the level of
cm long. The pancreatic duct runs along the glucose in the blood. This is the opposite jj
liddle of the pancreas and empties into the function to insulin. The level of glucose In
»
10 it supplies pancreatic enzymes, the blood is called either blood suga
>0 called pancreatic juices, which aid in ( BSL) or blood glucose level (BGL). h
gestion process. This is described as stimulates cells in the body to use or store
L •. ;ocrine function of the pancreas, exo the glucose produced from the metabolic
Uftii meaning ‘out of. Pancreatic juices flow out carbohydrates in food. Glucose is used in fhej!
of the pancreas through the pancreatic duct. body as an energy source.
The pancreatic duct is joined
1;. : by the common bile duct
before emptying into cells
the duodenum. The
pancreas also has an
gall bladder
endocrine function,
!ii endo meaning ‘ within’.
This is the release of
hormone within the
bloodstream. There
are four main types / v
of hormone produced
common Q>
in the hormone - bile duct •

producing cells of the
* *
pancreas - the islets «
of Langerhans (islet
.
cells) One of the four Cr.i i pancreatic duct
a; tell types - beta cells

* produce insulin. The
r
function of insulin is
duodenum
\
to lower the blood
sugar level. Beta
J
cells make up almost
b In pairs, practise explaining the role of the pancreas to a patient who

has recently been diagnosed with diabetes. Student A , you are the nurse;
Student B, you are the patient . Swap roles and practise again.

Explaining hypoglycaemia and diabetes
5 a Match the medical terms ( 1 - 10) to their meanings (a-j).
1 pancreas a the condition where the blood is more acidic than the surrounding tissues
2 diabetes b oral medication used to lower blood sugar levels
3 diabetic c the organ which produces insulin, which regulates blood sugar
4 hypoglycaemia d a person who suffers from diabetes
5 hypoglycaemic agent e disease characterised by high levels of sugar in the blood
6 glycosuria f the by- product produced when fats metabolise
7 ketones g hormone produced in the beta cells of the pancreas
8 diabetic ketoacidosis ( DKA) h presence of glucose in the urine
9 insulin i amount of glucose in the blood
10 blood sugar level ( BSL) j a low level of sugar in the blood
b Underline the stressed syllable in words 1- 10.
C Complete the next part of the information leaflet using the words
in the box . Then listen to a conversation between Nadia , a Diabetes
Specialist , and Beth , a recently diagnosed diabetic , and check your
answers.
pumps oral injections normalise fuel fat regulates inhalers
90% children beta liver glucose wstifw
The normal pancreas produces a hormone diabetes and is often the cause of diabetes
fasuUn in the beta cells. in (9) _ . Daily or twice-daily ;
Insulin ( 2.) blood sugar levels (10) of insulin are needed

fe: iBSL) by moving (3) from the by people with Type 1 diabetes. When the
blood into the muscle (4) . pancreas produces too little insulin, this l<
cells. This means that called Type 2 diabetes and makes up abou
glucose can be used as (6) (n)- of all cases of diabe LC>.
for the body. This type of diabetes may be treated
with an (12) _ hypoglycaemic
The diabetic pancreas may not produce
medication and sometimes also with
any insulin at all in the (7)
insulin injections. Two new devices, insulin
cells, or produce too little insulin to
_ blood sugar levels If no (13) - and insulin
PJ . (14) - , offer great
insulin is produced, this is called Type 1
improvements in lifestyle for all diabetics
d In pairs, practise explaining the role

of insulin in diabetes. Student A ,
you are a nurse; Student B , you are
a diabetic patient. Swap roles and
practise again.

e Recent advancements in diabetes research have provided diabetic patients
with a
number of options to assist with the self -management of their diabetes.
4.4 Listen to the rest of Beth and Nadia ’s conversation and match
the
options ( 1- 3 ) to the pictures ( a-c ) .
Option 1 Option 2 Option 3
f
^ 4.4 Listen again and complete the last part of the information
leaflet.
Option 1
• One or two types of insulin can be
• Worn all the time, delivers a (8) in the syringe.
(1) sfeouAy -ROLM of • Markings on the side of the syringe
insulin throughout the day. can be difficult to see, which
• Rapid or short -acting insulin is makes drawing up (9)
delivered through a ( 2) more difficult.
placed under the skin. • Cheapest option but least
• Give an extra, or (3) (10)
dose to cover times when more
carbohydrate is eaten during a meal or Option 3
Snack. • Insulin (11) fits into the
• Patient has fewer (4) device and can be changed.
in blood glucose levels. • (12) devices
• Most expensive option. are disposable and easier for diabeti
who have arthritis or are visually
Option 2 impaired.
:
• Insulin is drawn up from a • Easier to use and more
(5) into a (13) than syringes; can
m syringe. even fit into your pocket!
• (7) doses can be drawn • Needle is inserted on the
up if needed. (14) of the device and
changed with each injection.
g In pairs, discuss the advantages and disadvantages of each option. Which

one would you recommend for Beth? Which one would you choose if you were
Beth?

Charting and documentation: Diabetic Chart
6 8 Mrs Alice Wilson , on insulin -dependent diabetic, has been admitted to her local
hospital after a series of hypoglycaemic attacks. Mrs Wilson’s blood sugar
levels are being monitored closely as well as the glucose and ketone levels in
her urine.
Look at the Diabetic Chart . In pairs, answer the following questions.
1 What information is recorded on a Diabetic Chart regarding a patient’s
diabetes?
2 How often does Mrs Wilson have her blood sugar level taken?
3 What else does the nurse test for glucose apart from Mrs Wilson’s blood ?
4 What action is taken if she has a hypo?
5 What does the nurse do after she has a hypo to monitor the situation ?
U/N: 562894
DIABETIC CHART Surname: Wilson
Given names: Alice
Name AMice Wilson Weight 68kg DOB: 1921 Sex: Female
Date 5.5.08 6.5.08

Time 02.00 07.30 11.30 16.30 21.30 02.00 07.30 11.30 16.30 21.30
25
20
15
10
0
BSL 4.8 5.2 5.7 6.1 15 8.4 6.5 2.2 5.9 5.8
u /a glucose - ve + ve
u / a ketones -ve - ve
Hypo time 03.00 11.30
Hypo BSL 1.8 2.2
Action taken I'ade I'ade
10 min BSL 4.0 4.3

b 4.5 Listen to Peter, the Ward Nurse, handing over Alice Wilson to Christie, a
nurse on the next shift , and mark the following statements True (T) or False (F) .
1 Mrs Wilson has been having a few hypos lately.
2 She is 95 years old.
3 She’s having insulin to try and stabilise her.
4 She’s on qds plus 2 am BSL.
5 Her blood sugar levels should be between 4 and 8 mmols before meals.
6 Her blood sugar levels should go over 10 mmols half an hour after a meal.
7 Alice is still eating the wrong types of food.
8 Her BSL went up to 25 in the evening.
9 The Dietitian and Diabetes Educator will both visit Alice.
10 Alice has not had a hypoglycaemic attack today.
C iS Listen again and correct any mistakes on Alice’s chart on page 36.
d Based on her chart , how would you describe Alice ’s diabetes?
e In pairs, practise handing over Alice Wilson. Student A , you are Peter ; Student
B , you are Christie. Use the corrected chart on page 36. Swap roles and practise
again.
In small groups, discuss the following questions and then feed back your
group’s ideas to the class.
• Diabetes management is especially important for elderly patients. What
sort of information do they need?
• What co-morbidities (diseases that exist at the same time as another
illness) in the elderly might make diabetes management more difficult?
• How could you best help an elderly patient with diabetes management?

UNIT 5
• Explaining pathology tests
• Asking for clarification
• Checking understanding
• Telephone skills: contacting
other staff
• Explaining renal failure
• Softening a request
• Explaining urinary catheters
• Reading a Pathology Report
Explaining pathology tests

1 Are you familiar with the Pathology department
in hospital? What kinds of test are done there?
2 Why is it important for nurses to understand the results of pathology tests?
b 5.1 Listen to a conversation between Mrs Faisal , a patient, and Frances,

the Ward Nurse, and answer the following questions.
1 What symptoms does Mrs Faisal have?
2 What condition might she have ?
3 What is the name of the test which will be performed at Pathology ?
4 What does Frances have to collect from the patient ?
Communication focus: asking for clarification

• If you were unsure of an instruction or some information, how would you ask
for clarification in English ?
• Why is it important to clarify any instructions you don’t understand?
b si Listen again. Match the extracts ( 1- 5 ) to the responses ( a- e).
1 It burns when I go to the toilet,

and I have to go all the time.
.
a Yes, the sample is less likely to have bacteria ..
2 Is that right?
.
b Yes It hurts when the urine comes out, ...
3 What was it ? .
c Right So what you're saying is that it hurts when you're
4 He'll want you to do a urine actually passing urine ...
specimen ... d Its full name is urinary tract infection.
5 Less contamination ? e OK. So you want me to do a urine specimen, do you ?
38 Unit 5 Medical specimens

the box.
C Complete the following clarification strategies using the words in
intonation repeat paraphrase clarify

i 1 the information back to the speaker,
2 what has been said.
3 Use a questioning . pattern.
4 Ask the speaker to . what they have said.
d In pairs, practise using the clarification strategies to respond to the

following sentences.
• I’ve got a lot of problems when I go to the toilet.
• It burns when I go to the toilet.
• I have to go to the toilet all of the time.
• You might have a urinary tract infection.
• The doctor will want you to do a urine specimen.
• There’s less contamination with a midstream specimen.
e In pairs, practise giving information and asking for clarification . Student

A , you are Frances; Student B, you are Mrs Faisal . Remember to use
the
clarificatio n strategies. Swap roles and practise again .

your
• How do you ensure privacy for your patients?
• What cultural issues are important in providing privacy?
• When might a patient request a chaperone?
Communication focus: checking understanding

,
5.2 Listen to the rest of the conversation between Mrs Faisal and Frances
3 a
^
and put the following extracts in the correct order.
Try to catch the middle part of the urine stream.
You need to clean the area around the urethra from front to back with these
disposable wipes.
Tighten the lid before you give me the specimen container, please.
Don’t touch the inside of the container when you take the lid off.
CO Wash your hands thoroughly.
b Frances uses several strategies to check understanding. Match the
strategies ( 1 -4 ) to the expressions from the dialogue ( a- d) .
1 Ask the patient to repeat the information a Could you repeat back the steps for me so
back to you I can be sure you followed my explanation?
2 Ask the patient to demonstrate the use of b Do you understand/see what I mean ?
the equipment
3 Ask for clarification to ensure the patient c Can you show me how you'll hold the
understands what has been said specimen jar?
4 Ask the patient to list the steps of a d Right, so step one is?
procedure or process
Unit 5 Medical specimens 39

C In pairs, practise asking for and giving instructions for a midstream
urine specimen (MSU). Student A , you are a nurse; Student B, you are
a patient. Remember to use the strategies for clarification and checking
understanding. Swap roles and practise again.
Telephone skills: contacting other staff

1 What hospital communication systems are you familiar with ?
2 What do you think are the features of a good communication system ?
3 How is technology changing the way we communicate in the workplace ?
b sj Listen to a telephone conversation between Frances and Dr Sinclair,

an SHO, and mark the following statements True (T) or False (F).
1 Frances calls Dr Sinclair to check on the results of Mrs Faisal’s urine test.
2 Dr Sinclair asks Frances to remind her about Mrs Faisal’s diagnosis.
3 The doctor has decided not to prescribe antibiotics.
4 A midstream urine specimen has been collected from the patient but the
nurse needs the doctor to sign a Pathology Form.
C u Listen to the conversation again and complete the following extract.

Frances: It’s Frances from eight west here. I’m ( 1 ) C<nlUv\ q
.
one of your patients Mrs Faisal.
.
Dr Sinclair: Er Mrs Faisal ? Can you (2) ?
Frances: Yeah, she was admitted two days ago, er ...

.
Dr Sinclair: Yeah , I remember Isn’t she (3) the
removal of an ovarian cyst ?
Frances: Yeah, that’s the patient. I think she may have a UTI . She’s
(4) frequency, urgency and pain when
she passes urine.
Dr Sinclair: Right. Is she (5) ?
Frances: Yeah, her temp's (6)

She’s around thirty-seven point eight. She doesn’t feel brilliant
either - general (7)__
Dr Sinclair: ... Can you take an (8) and I’ll come over and
(9) some antibiotics.
Frances: The MSU’s already done, but I’ll leave the ( 10) *
at the desk to be signed. Then we can send it to

Pathology...
d In pairs, practise the telephone conversation. Student A , you are Frances;

Student B, you are Dr Sinclair. Remember to use the strategies for
clarification and checking understanding. Swap roles and practise again.

for a midstream
C In pairs, practise asking for and giving instructions
t B, you are
urine specimen (MSU). Student A , you are a nurse ; Studen
es for clarifica tion and checking
a patient . Remember to use the strategi
understanding. Swap roles and practise again.
Telephone skills: contacting other staff

with ?
1 What hospital communication systems are you familiar
system ?
2 What do you think are the features of a good communication
we commun icate in the workpla ce?
3 How is technology changing the way
and Dr Sinclair,
5.3 Listen to a telephone conversation between Frances
b
^
an SHO, and mark the followin g stateme nts True (T ) or False (F ) .
’s urine test.
1 Frances calls Dr Sinclair to check on the results of Mrs Faisal
to remind her about Mrs Faisal ’s diagnosis.
2 Dr Sinclair asks Frances
3 The doctor has decided not to prescribe antibiotics.
patient but the
4 A midstream urine specimen has been collected from the
nurse needs the doctor to sign a Patholog y Form .
C s.S Listen to the conversation again and complete the following extract.
Frances: It ’s Frances from eight west here. I’m ( 1 )
one of your patients, Mrs Faisal.
?
Dr Sinclair: Er, Mrs Faisal ? Can you (2)
Frances: Yeah , she was admitted two days ago, er ...
the
Dr Sinclair: Yeah, I remember. Isn 't she (3 )
removal of an ovarian cyst ?
Yeah, that’s the patient. I think she may have a UTI. She s
’
France s:
W frequency, urgency and pain when
she passes urine.
Dr Sinclair: Right. Is she ( 5)
_ ?
Frances: Yeah, her temp ’s ( 6)

She's around thirty-seven point eight. She doesn t feel brilliant
’
either - general (7 ) _
..
Dr Sinclair: . Can you take an (8) and I’ll come over and
(9) some antibiotics.
•
Frances: The MSU’s already done, but I’ll leave the ( 10)
at the desk to be signed. Then we can send it to
Pathology...
A , you are Frances;

d In pairs, practise the telephone conversation . Student
ber to use the strategi es for
Student B , you are Dr Sinclair. Remem
g understanding. Swap roles and practis e again.
clarification and checkin

Medical focus: the kidneys
• How important is the role of the kidneys in our overall health ?
• Have you had experience of caring for a patient with a kidney problem? If
so, how did you manage his/her condition?
b Read the patient information leaflet and answer the following questions.
1 What are the functions of the kidneys?
2 What are the filtration units of the kidney called?
3 Which part of the kidney controls salt and water concentration levels?
4 Which part of the urinary system stores urine?
5 What is the tube that carries urine outside the body called ?
How do your kidneys work?

Unfiltered blood enters the kidney for filtration through
the renal artery from the heart. Blood passes to the cortex medulla
kidneys in large quantities so that it can be filtered
well and have most of the waste products removed . renal vein
Renal veins carry the cleaned blood away from each
kidney. Renal veins are wider than renal arteries pelvis 1
because they transport blood towards the inferior
vena cava of the heart. The blood returned from the . renal jt
heart through the renal artery contains a toxic product, artery
called urea, and also high levels of salt and large

amounts of water. The kidney’s function is to filter out
these unwanted materials. In addition, the kidney also ureter
reabsorbs any products the body needs and secretes

waste materials as urine.
Blood enters the kidney through the hard outer layer, or cortex. The filtration units of the kidney,
called nephrons, are found in the renal cortex. The nephrons help to filter out waste from the
blood, leaving a filtrate of important salts and glucose. The next section of the kidney is called
the renal medulla. This is where the level of salt and water in urine is controlled. Sodium ions
are concentrated in the medulla so that very concentrated urine is produced. Any excess water
and waste products are then secreted as urine. The urine collects in the renal pelvis, which
is the fan -shaped section at the narrowest part of the kidney that joins onto each ureter. The
ureters are the two tubes which transport the urine from the kidney to the bladder, or storage
section. From the bladder there is another tube called the urethra which is where the urine
passes to the outside.
C In pairs, practise explaining how the kidneys work. First, use the
information leaflet to help you . Then try using just the diagram of the
kidney. Swap roles and practise again.

Explaining renal failure
6 a Match the medical terms ( 1- 1 3) to their meanings (a- m).
1 urinalysis a the measurement of how acidic or alkaline a solution is
2 urine b a toileting receptacle which is used by bed- bound patients
3 urinal c a sample, usually of urine or blood
4 bed pan d protein in the urine, also called albuminuria
5 renal e the process of analysing urine using physical or chemical tests
6 pH f blood in the urine
7 proteinuria g also called bottle; used by male patients to pass urine into
8 haematuria (US hematuria) h relating to the kidneys
9 specimen i the fluid which is excreted by the kidneys
10 oedema j no urine output
11 anuria k excessive accumulation of fluid in the tissues
12 nephrons l low urine output
13 oliguria m filtering units of the kidney
b Underline the stressed syllable in words 1 - 13 .
C In pairs, take turns to say a word and ask your partner to explain it .
d M Mr Zelnic has been admitted to the renal ward for renal function
tests. He has been passing blood in his urine for the past two weeks and
has lower back pain . Listen to the conversation between Everson, the Ward
Nurse, and Mr Zelnic. Mark the following statements True (T) or False (F).
1 In kidney disease, there is a build-up of toxic waste products in the blood.
2 Oliguria is a symptom of end stage renal failure.
3 Fluid retention indicates that the filtration system of the kidneys has failed.
4 End stage renal failure can be treated.
5 The symptoms of kidney disease appear immediately.
e M Listen again and complete the following extracts using the words in
the box.
toxic oedema nephrons renal failure renat urine lethargic renal transplant
1 If the kidneys stop working properly, , or kidney, disease could

be the result.
2 If the don’t filter properly, the waste products aren’ t removed.
3 Eventually, levels of waste products build up in the blood.
4 Oliguria can be a symptom of the early stage of
5 If the kidney disease is untreated, the nephrons stop working altogether and
no is passed at all.
6 Because your kidneys are not filtering out waste products or excess water,
your hands or feet may swell; this build-up of fluid is called
7 You may also feel because your blood hasn’t been cleaned
and can t function
’ properly .
8 People with end stage renal failure have to go on dialysis or perhaps even
have a

Communication focus: softening a request
7 a w Listen to the rest of the conversation between Everson and Mr Zelnic
1 What kind of specimen is needed for urinalysis?
2 What three things can the urinalysis check for ?
b Look at the following sentences. Are these the same as sentences you
heard in the conversation between Everson and Mr Zelnic? If not , which
words are missing?
1 I’d like you to do it now, if that’s all right.
2 I need an ordinary sample of urine.
3 It takes a few minutes to get a reading.
4 I’m checking for proteinuria; that means protein in the urine.
5 Ring when you want me to collect it.
C s.B Listen to the sentences with the words missing.

d s? Now listen to the sentences with the words included. How does adding
the missing words soften the request?
e In pairs, practise explaining the urinalysis test. Student A , you are

Everson; Student B , you are Mr Zelnic. Remember to use the strategies
for clarification and checking understanding, and to soften instructions
appropriately. Swap roles and practise again.
Explaining urinary catheters

Short -term urinary catheters may be inserted in patients who have urinary
retention, or have restricted movement which does not allow them to get up
to the toilet easily . Long -term urinary catheters are used for patients who are
permanently incontinent.
8 d In pairs, discuss the following questions.

1 Are you familiar with the use of urinary catheters?
2 What other types of patient might require urinary catheters?
3 What are some of the complications that can occur with catheterisation?
4 Are you aware of any new procedures/ developments in catheterisation ?
b s.B Listen to a conversation between Mrs Kastel, a patient, and Jo , her

nurse, and answer the following questions.
1 What is Mrs Kastel complaining of?
2 What is Jo going to do to relieve Mrs Kastel’s problem ?
3 What is used to collect the urine ?
C Complete the following definitions.

1 Urinary retention is when a patient can't
2 An indwelling catheter (IDC) is a tube which is left _
, or in place.
3 Aseptic technique keeps equipment sterile to avoid
4 A catheter drainage bag is a bag which collects the urine that
drains out of the urinary catheter.
* Unit 5 Medical specimens 43

d 5.8 The nurse and patient both use strategies for clarification by
rephrasing information. Listen again and match the original information
( 1 -6) to the rephrased version (a- f) .
.
1 I haven't been able to use this bedpan at all ' a Is that the tube which goes into your bladder?
2 You've still got some urinary retention after b That's exactly it. It's called aseptic technique
your operation, haven't you? because it keeps equipment sterile to avoid
3 I might have to put in a catheter to drain the contamination,
urine. c I mean, left in place.
4 ...a tube which is left in situ - d You mean that you haven't been able to pass any
5 And you have to take care how you put the urine?
.
tube in so I don't get an infection e It's a transparent bag which collects the urine that
6 The catheter bag you're talking about is one drains out of the catheter,
of these. f You mean that I can't go to the toilet ?
e In pairs, practise explaining an IDC. Student A , you are a nurse; Student B,

you are a patient complaining of urinary retention . Swap roles and practise
again.

Pathology Report
Pathology Reports are usually sent to the ward via the hospital intranet .
A paper copy is also sent to the ward and filed in the patient's notes as a
permanent record.

1 Are you familiar with Pathology Reports ?
2 What sort of information do they contain ?
3 When do nurses refer to them ?
4 Are you familiar with Pathology Reports online, i.e. on the hospital intranet ?
5 When would a nurse phone a patient’s doctor about a pathology result ?
b In pairs, look at the Pathology Report on page 45 and answer the following
questions.
1 What information does this Pathology Report contain?
2 What test was performed?
3 What type of specimen was collected?
4 What time was the specimen collected?
5 When was the specimen analysed in the lab?
6 What did the pathologist notice under the microscope ?
7 What do you think proteus mirabilis is the name of?
8 What kind of drugs are ampicillin , cephalexin, trimethoprim and
nitrofurantoin?
9 What comment did the pathologist make about Mrs Chu's specimen ?

Pathology Report
Name: Gloria Chu
Lab No: 4524368 Micro No: GC06M74
Collected: 18:45 6-Mar- 08
Urine microbiology
Registered: 07:18 7-Mar-08
Specimen: MSU
Ward of collection: 16E
Microscopy:
Leucocytes 40 x 10 / LRR ( <10)
°
Crythrocytes 20 x 10'’ / LRR ( < 10 )
Other bacteria 1 +
Antimicrobials: Not detected
Culture: Proteus mirabilis > 10P / L
Ampicillin Sensitive
Cephalexin Sensitive
Trimethoprim Sensitive
Nitrofurantoin Sensitive
Comment: Possible UTI
C Complete the following explanations using the words in the box

.
antimicrobial erythrocytes culture

pathology
microscopy bacteria sensitive
microbiology
microbes leucocytes
1 Elevated 0r white blood cells, can indicate infection.

t
2 The bacteria in Mrs Chu 's urine is to ampicillin, so she started

treatment with the antibiotic this morning.
3 The presence of in the urine strongly suggests that Mrs Chu has
a UTI.
4 , which include viruses and bacteria , are infective agents.
drugs.
5 Medications which attack microbes in the body are called
6 The study of micro organisms - that
- is .
organisms which cannot be seen by the
naked eye - is called
7 Red blood cells, also called , transport oxygen in the blood.
8 The study of diseases is called
9 is the use of a microscope to visualise the presence of microbes
in specimens.
analysed by a
10 The population of microbes which is grown in a laboratory and
pathologist is called a

1 Why is it important to identify the organism which causes infection?
2 Why is the overuse of antibiotics a problem ?
3 What is MRSA and what can it cause?
4 Is MRSA a problem in your country?

UNIT 6
• Administering medication
• Doing a medication check
• Working as part of a team
• Checking medication orders for
accuracy
• Explaining drug interactions
• Checking the 'five rights' of
1
JMMMpmi
medication administration >
• Reading a Prescription Chart
Administering medication
The use of controlled drugs (CDs ) is regulated by
legislation. The legislation sets out rules for the
safekeeping of controlled drugs , the records which
must be kept , and the manner of administering controlled drugs.
l a i n pairs, discuss the following questions.

1 What is your experience of administering controlled drugs?
2 What is your experience of drug prescriptions?
3 What rules relating to the administration of controlled drugs are there in
your country ?
4 Why are controlled drugs regulated so strictly?
b 6.1 Natasha , a Ward Nurse, needs to give her patient , Mr Song,

an injection , and she is looking for a nurse to help her. Listen to the
conversations and answer the following questions.
1 Why does Natasha need assistance ?
2 What medication is Natasha going to give Mr Song?
3 Why can’t Marek help her?
4 Is Anna able to help ?
C Natasha asks for the assistance of other nurses. Match the beginnings
( 1 - 4 ) to the endings (a-d). Sometimes more than one answer is possible.
1 Have you a free at the moment?

2 Are you b checking this morphine with me, please ?
3 Are you c got a minute? I just need a drug check,
4 Would you mind d busy at the moment or can you do a drug check with me ?
46 Unit 6 Medications
d 6.1 Listen again and check your answers. Then match the questions in
Exercise 1 c to the correct responses (a-d).
a Sorry, Natasha, I'm tied up at the moment,
b Oh sorry, Natasha, I can’t at the moment. I'm just in the middle of
something, and I can't leave it.
c Yes, sure. Let me just wash my hands and I'll be with you.
d I will be in a minute.
e Complete the following extracts using the words in the box. What do all the
expressions mean?
snowed flat out eyeballs run off
1 No, sorry. I’m up to my in work ,
2 I’d love to help, but I’m under.

3 I can’t. I’m at the moment.
4 Actually, I’m _ my feet.
f In pairs, practise asking for assistance with a drug check , using Exercises
Ic- e as a guide. Swap roles and practise again.
Doing a medication check

2 a 6.2 Natasha and Anna have gone to the Treatment Room to get some
medication for Mr Song. Listen to the conversation and answer the
following questions.
1 Which drug has the doctor prescribed for Mr Song?
2 Why does Natasha ask Anna to get the drug from the drug cupboard ?
3 What do they have to do when they take the ampoules from the cupboard?
4 What do they have to do in the drug book ?
5 What information does Natasha show Anna on the ampoule ?
b ei Listen again and put the following steps in the correct order.
Check the number of ampoules left in the cupboard
Draw up the correct amount of the drug in a syringe
Check the expiry date of the drug in the ampoule
Check the time the last injection was given to the patient
Q] Check the drug order in the Medication Chart
Sign and witness the drug book
Check the amount of drug drawn up in the syringe
Get an ampoule from the locked cupboard
C In pairs, try to remember the order of the steps in a medication check

without looking at Exercise 2 b.
Unit 6 Medications 47
d Match the strategies for correct administration of a medication ( 1 - 6 ) to
the rationales (a-f).
1 Anna checks that the drug count is correct before

a Out - of- date drugs may not be effective.
checking out an ampoule of pethidine for Mr Song.
2 Natasha checks the prescription in the Prescription b This ensures that none of the ampoules have been taken
Chart with Anna. and misused.
c This is to prove that the syringe contains the controlled
3 Natasha and Anna check the ampoule together . drug, not another colourless liquid.
4 Natasha and Anna check the expiry date on the d This ensures that the correct drug and dose is checked
ampoule. out.
5 Natasha draws up the correct amount of the drug in the e This proves that the patient has received the controlled
syringe and shows Anna . drug .
6 Anna watches Natasha give Mr Song the injection of
f Controlled drugs may only be given with a written order.
pethidine.
e In pairs, practise assisting with a drug check . Student A, you are Natasha;
Student B , you are Anna . Use Exercise 2b as a guide. Swap roles and
practise again.
Communication focus: working as part of a team

There are many occasions when teamwork is critical in the healthcare environment.
3 Match the strategies for working as part of a team ( 1 - 6 ) to the examples

(a-f) .
a Thanks for helping me, Hans. It was much easier to do
1 Ask for assistance politely
this together.
b - Mrs Cho is refusing to drink anything.I don't know
2 Share the workload what to do.
- Have you tried apple juice? I know she'll drink that,
c Would you mind giving me a hand? I need someone to
3 Acknowledge the contribution of other staff
check this medication.
d I'm really snowed under at the moment. Can anyone else
4 Provide alternative suggestions
help you?
5 Be an active part of a team rather than work as an
e I've finished all my work. Does anyone need a hand ?
individual
f Do you mind taking beds one and two, and I'll take
6 Recognise when you're unable to help
three and four ?

1 What do you understand by the term team nursing ?
2 What are some advantages of team nursing?
3 What are some disadvantages of team nursing?
4 What nursing styles are you familiar with or have worked under (for
example, holistic nursing, primary care nursing, task oriented nursing) ?
Checking medication orders for accuracy
Some medications must be checked by two nurses before being given to the
patient. It may also be necessary to check the result of a blood test before the
medication can be given. In the following case, the patient has had a blood test
to check the International Normalised Ratio (INR). The INR measures the time it
takes for a blood clot to form in the body .

1 What sort of medications need to be checked by two nurses, and why ?
2 Why do some medications require a blood test before being given ?
b M Josh and Susanna, two Ward Nurses, are checking a medication

together. Listen to the conversation and answer the following questions.
1 What does Josh want Susanna to do?
2 Who is the medication for ?
3 What kind of medication is it?
4 What result do the nurses check before giving the medication ?
5 Who signs the Prescription Chart ?
C M Put the following stages of Josh and Susanna ’s medication check in

the correct order. Listen again and check your answers.
Check the medication label
Crosscheck chart and patient information
Check the INR result
Sign Medication Chart
Crosscheck route
EE Ask for help
Crosscheck dose on Medication Chart
Take out medication
Countersign Medication Chart
Crosscheck time of administration
d Mrs Egerts in bed 6 has been prescribed warfarin 5 mg to be taken

orally. In pairs, practise checking medication orders. Student A , you are
Josh; Student B , you are Susanna. Remember to crosscheck all of the
information. Swap roles and practise again.

1 Do you follow the same procedures for checking medication in your
country ?
2 If not, what procedure do you follow?
3 What are the advantages and disadvantages of having a single
designated nurse for the medication round?
Medical focus: the metabolism of medication
Patient education in medication safety
Mr Albiston has just been prescribed atorvastatin to lower the levels of cholesterol
in his blood. In order to ensure the safe usage of the medication when Mr Albiston
returns home, Helen, the Ward Nurse, is going to talk to him about his medication.
5 3 In pairs, answer the following questions.

1 Why is patient education about medications an important role for nurses ?
2 What are some of the risks of self -medication ?
3 What sort of things might a nurse discuss with a patient regarding a new
medication?
b M Listen to the conversation between Helen and Mr Albiston and mark the
following statements True (T) or False (F) .
1 Atorvastatin is used for patients with low cholesterol levels.
2 The medication stops atherosclerosis in the arteries.
3 The drug is absorbed in the liver.
4 Atorvastatin blocks the enzyme which causes the liver to make cholesterol.
5 It doesn’t matter what time of day atorvastatin is taken.
C M The diagram below shows the absorption and metabolism of

atorvastatin. Listen again and complete the following patient information
leaflet.
After you swallow the tablet, it (1) _ ev\Fevs

.
the gastrointestinal tract, or GIT * It
(2) the
mouth oesophagus, the tube which (3)
.
the stomach The tablet passes
into your stomach, where it is absorbed. It
oesophagus (4) the liquids
there so it can pass into your bloodstream .
It then (5) the
heart the small intestine,
liver (6) _
the part under the stomach. The drug is
(7) , or chemically changed, in
stomach
the liver. The liver stops the production of an
enzyme which (8) the body to
liver produce a harmful type of cholesterol.
By (9) this enzyme, the amount
of ‘bad cholesterol’ which is (10)
small intestine the blood is reduced.
* a series of organs of the digestive system which
runs from the mouth to the anus
anus
d In pairs, practise explaining the metabolism of medication. Student A , you are

a nurse; Student B , you are a patient . Use the diagram in Exercise 5 c to help
you . Swap roles and practise again.
Explaining drug interactions
6 3 Read the information leaflet about
atorvastatin interactions and answer the
following questions. Atorvastatin interactions
1 What drugs are contraindicated (not
advisable) with atorvastatin ? .
which decrease its elimination from the body For
2 Why would decreased elimination of example, drugs such as the antibiotic erythromycin
arid the anti- rejection drug cyclosporine lb.OfliiMUM
atorvastatin be problematic ? ^
3 What other things are contraindicated?
could increase levels of the atorvastatin In the body
b Complete the following precautions using and Increase the risk of muscle da
the phrases in the box .
Statins should not be combined with niacin (nicotinic
should/must not be taken are warned not
increases the toxic effects lower cholesterol and present in multivitamin tablets.
precaution to take advised not to
should be must not take increasing the risk Atorvastatin increases the anticoagulant effect of
v\ of fo
warfarin, so patients taking atpTva&atin and warfarin
1 You are drink
alcohol with the medication, as this can
increase the risk of liver disease. Statins may cause liver disease, such as jaundice,
so it is necessary to monitor fiver function. Alcoholic
2 The medication
beverages must be limited or avoided.
with drugs such as the antibiotic
erythromycin and cyclosporine, as these Large quantities of grapefruit juice (more than 1.2
reduce the elimination of atorvastatin from
the body of inhibits an intestinal enzyme whose function It Is
muscle damage. to break down and absorb medications. When this
3 No statins enzyme is blocked, the blood level of the drug
combined with niacin (nicotinic acid). increases, and toxic side effects from the medication
4 You warfarin may be felt.
and atorvastatin together as this increases
the anticoagulant properties of warfarin. (often used in marmalade), should also be avoided.
5 Atorvastatin
with grapefruit juice as this stops
a vital enzyme from working and
of the drug.
6 Not eating citrus fruit related to grapefruit is an important
to avoid side effects.
in
C Adverse events relating to medications are a significant and costly problem
hospitals. Several strategies have been introduced to Best Practice which aim
for
to reduce medication errors. One such strategy is the use of pharmacists
and review of medication charts at ward level . Pharmacists usually
consultation
visit the ward once a week .
6.5 Listen to a conversation between Helen, a Ward Nurse, and Sonia , the
hospital Pharmacist , and answer the following questions.
1 What is Sonia doing?
2 What is she speaking to Helen about?
3 Why is Sonia concerned?
4 What is nicotinic acid also known as?
5 What action will Helen take ?
d fiJ Listen again and complete the following extracts.
1 I had a talk to him about some things he’ll
careful of at home.
2 .
.. when he started atorvastatin
about something he was started on today.
3 He taking that with atorvastatin.
4 He Vitamin B 3 - I mean, nicotinic acid - on its
own or in any other preparation.
5 Does he know drink grapefruit juice with the
atorvastatin ?
e In pairs, practise explaining the interactions of atorvastatin. Student A , you

are a nurse; Student B, you are a patient who has just been prescribed the
drug for the first time. Swap roles and practise again .

Prescription Chart
7 d Sonia, the hospital Pharmacist, has just checked Mr Albiston’s Prescription
Chart on her regular ward visit . In pairs, look at the chart on page 88 and
discuss the following questions.
1 What kind of chart is it?
2 Are you familiar with this style of chart?
3 What sort of information is on the chart ?
4 Who is responsible for recording information on the chart?
5 How often is new information added to the chart ?
b The following abbreviations are all commonly used on Prescription Charts.

Match the abbreviations ( 1- 10) to their meanings (a- j).
1 tab. a injection given into the subcutaneous layer of the skin
2 cap. b at night
3 mg c injection given into the muscle
4 meg -
d milligram unit of mass which is 1/1000 of a gram
5 ml e millilitre - unit of volume which is 1 1000 of a litre
/
6 po f gelatine - coated medication
7 sc g microgram - unit of mass which is 1/1000 of a milligram
8 IM h solid medication, also called a pill
9 mane i from the Latin per os: by mouth
10 nocte j in the morning
C Which of the abbreviations in Exercise 7 b are found on the Prescription

Chart on page 88?
d In pairs, take turns to ask for the meaning of an abbreviation .
e In pairs, look at the chart on page 88 again and answer the following
questions.
1 When was Mr Albiston ordered atorvastatin ?
2 What time does he have to take the medication?
3 Has he already started taking the medication?
4 What new medication was Mr Albiston ordered on 28 April?
5 Has he already been given this medication?
6 Would you give Mr Albiston the medication ordered on 28 April ?
Checking the 'five rights' of medication administration

8 a In pairs, look at the ‘five rights’ and discuss the following questions.
• checks
Are these the same medication
which are performed in
The ’five rights'
your country ? 1 The right drug
• If not, how are they different ? 2 The right patient
3 The right dose
• How would you check them? C
4 The right route
5 The right time
b ei Beatriz, a Student Nurse, is doing a medication assessment with Jo , a

Registered Nurse. Listen to the conversation and mark the order that Beatriz
checks the five rights in.
C Match the ‘ rights’ ( 1 - 5 ) to their meanings (a-e).

1 The right drug a Check the route of administration on the Prescription Chart
2 The right patient b Check how often the medication is to be given and at what times
c Crosscheck the name of the medication on the Prescription Chart
3 The right dose
and the medication label
d Crosscheck the dose of the medication on the Prescription Chart
4 The right route
and on the medication label
e Check the patient's full name by checking the hospital label on the
5 The right time Prescription Chart and by checking the patient's identity bracelet;
also check the patient's date of birth if necessary
d In pairs, practise doing nurse-nurse medication checks. Look at Mrs

Gupta ’s Prescription Chart on page 87 . Ask questions about the medication
administration , following the five rights. Swap roles and practise again.

• Do you have Nurse Prescribes in your country?
• What do you think are the advantages and disadvantages of having
Nurse Prescribers?
UNIT 7
• Reviewing IV infusions
• Passing on instructions to
colleagues
• Assessing IV cannulas
• Telephone skills: taking a
message about patient care
• Checking IV orders
• Charting fluid intake and
output
Reviewing IV infusions
IV infusions are treated in the same way
as medications. They must be prescribed
by a doctor on an IV Prescription Chart . IV
Prescription Charts only remain current for
24 hours, so doctors must review IV infusion
regimes daily .
1 What is your experience of IV therapy ?
2 When might a patient require IV therapy ?
3 What IV therapy equipment are you familiar with ?
b In pairs, look at the picture and discuss the following questions.

1 What equipment can you see ?
2 What do you think they are discussing?
C M Dr Venturi has come to the ward to review his patients’ IV infusion

regimes. Listen to the first part of his conversation with Paula , the Ward
Nurse, and mark the following statements True (T) or False (F).
1 Doctor Venturi wants to review Mrs Boland’s IV fluids.
2 Paula is looking after Mrs Boland all day today.
3 Mrs Dillip’s potassium levels are above average.
4 Mrs Dillip has been started on one litre of Normal Saline over eight hours.
5 Her antibiotics are to be given through a separate line.
6 Mr Claussen’s cannula will have to be resited before he goes home.
54 Unit 7 Intravenous infusions

d ?.! Listen again and circle the words or abbreviations (a or b) you hear.
1 a intravenous fluids
<b) IV fluids
2 a cannula
b IVC
3 a potassium
b K
4 a Normal Saline
b N /S
5 a millimols
b mmols
6 a potassium chloride
b KCI
7 a IV antibiotics
b IVABs
e ?.! Listen again and tick which instructions you hear.

1 Q Could you change Mrs Boland’s IV line when the infusion has gone
through, please ?
Could you take down Mrs Boland’s IV when it ’s finished, please?
2 Leave it (the cannula) for another day ...
Leave the infusion up for another day.
3 Could you start her on a litre of Normal Saline with 40 millimols of KCI?
Could you take down the litre of Normal Saline and put up a Normal
Saline with 40 millimols of KCI?
4 Can you run it over six hours, please?
7] Can you run it over eight hours, please?
5 Can you leave the cannula in for his antibiotics, please?
Can you take out his cannula before he goes home, please?
Passing on instructions to colleagues

2 a Paula makes notes of Dr Venturi ’s orders so that she can pass them on to Suzy
when she returns.
72 Listen to the second part of the conversation and write B for Mrs
Boland, D for Mrs Dillip, and C for Mr Claussen next to the information in
Paula’s notes which relates to them.
b Why did Paula put a tick next to three of the instructions in her notes?
Mc4“ £S For Su2y

[0 CCC *''itnu.)G. ivoS£'r 4“C<d Leave caûia
EH Ligh4 drCSSi^g
"
TGX £ dou' vo IV u>h£n

^ k levels
hWe 4”his
4 hr .
“
+
Pa - ap ( L M / S uii4"h kCl
IV gc *A *AOIS
IV ASs I I Caôuia cu4" /
Unit 7 Intravenous infusions 55

C
^ 12 Listen again and write down what Paula says to pass on the
instructions.
1 Take down IV when thr.
He i-P you c o f U .
g IV <Aowv\ wUgH If's vun Hwouqk
2 Leave cannula
3 Put up 1 L N /S with KCI 40 mmols
4 Run IV 8 °
5 Cannula out
d Dr Venturi has completed his rounds and has left instructions for two
patients. Student A , read the notes on page 88 and pass on the message
to your colleague, Student B. Student B, read the notes on page 93 and
pass on the message to Student A .

1 What protocols do you follow for checking IV infusions?
2 What protocols do you follow for the care of IV cannulas?
3 Do you use preloaded IV infusions - IV infusions which already include
.
additives; for example Normal Saline with 40 mmols KCI - in your
country, or do you load the additives before administering the infusion ?
4 What are the advantages and disadvantages of preloaded infusion bags ?
Medical focus: IV cannulas

Assessing IV cannulas
3 a 7.3 Listen to a conversation between Mrs Boxmeer, who is waiting for
her next IV infusion, and Angela , a Ward Nurse who is inspecting the IV
cannula site, and answer the following questions.
1 Why does Angela check the insertion site of Mrs Boxmeer’s IV?
2 What signs of infection does the nurse check for?
3 How many more doses of IV antibiotics does Mrs Boxmeer have ?
4 What is the problem with the location of Mrs Boxmeer’s cannula ?
5 What happens at the first sign of infection ?

b Match the medical terms ( 1- 9) to their meanings (a-i).
1 nosocomial
a describes an IV line which stops running because the line becomes blocked off due
to patient movement
2 phlebitis b redness of the skin which can indicate infection
3 infiltration c contracted in hospital; from the Greek noso- , meaning 'disease'
4 Staph d replace in a different vein
5 IV giving set e staphylococci bacteria - types of microbes which are usually found on the skin
6 erythema f inflammation of the vein; from the Greek phleb- , meaning 'vein'
7 aseptic technique g tubing which is spiked into the infusion bag and connected to the IV cannula; also
called an IV administration set
8 resite an IV cannula h 'no touch' method used to avoid contamination
9 positional i when fluid leaks into surrounding tissues; in nursing jargon: 'tissued'
C Underline the stressed syllable in words 1 - 9 .
d In pairs, take turns to say a word and ask your partner to define
it .
e 7.3 Angela explains to Mrs Boxmeer what happens when an IV cannula
needs to be replaced. Listen again and complete the following extracts.
1 Can I just check that your IV cannula is all right before I the
next infusion?
2 I’ll have a look on your Care Plan to see when the doctor the IV
3 It means that I'll call the doctor to come and a new one.
4 I’ll stop this drip now and your cannula.
5 Can’t they the cannula 7
6 Sorry, you’ve still got six doses of IV antibiotics, so we need to
a new line.
7 I hope they can find a more convenient spot to it
8 The thing is that there is a lower risk of phlebitis if we the cannula
your hand .
9 That’s why we check the cannula site and the cannula at the
first sign of infection.
10 Our hospital follows Evidence- Based Practice guidelines which suggest that
we IV cannulas after seventy- two hours.
11 The number of days the IV is is recorded in the Care Plan.
Telephone skills: taking a message about patient care

The telephone is one of the main instruments of communication in the
healthcare setting . Information about patient care is often given and received
by phone or via phone messages, so it is very important that this is done
accurately and clearly .
1 Under what circumstances would nurses need to use the telephone to
communicate information about patient care?
2 What sort of information would nurses receive by phone ?
3 Have you experienced any difficulties taking messages over the phone? If so,
what were they ?
4 How can you avoid misunderstandings when taking phone messages?

b Listen to a conversation between Dr Gonzalez, who has been paged
about putting in a new cannula , and Kasia , the Ward Nurse who takes the
message, and circle the details you hear.
Date of message 17 September 200S

Time of message 11.00 firs
Name of caller Or
Nature of call Kestte ccumla Mrs Szttlwuiskij
Instructions 1 MicUel to call Or Q re votien canniila needs resite
2 Oue time ne t IV 06s
3 6UepOr on 645
^
Message documented in
Patient Record
^
Yes / Not necessary
Signature of call recipient £ ToUvikaga (QJ)
C Look at the following guidelines for taking telephone messages. What did
Kasia say in each case?
1 Make sure you have the details of the caller’s identity.
|V\
SCYYY, I Ue<*v yoiAv pvopevly. WUo's cÔUtig, please?
2 Ask the caller to spell out any difficult names if you are unsure.
3 Make sure you understand the purpose of the call.
A Stop the caller if s/he is giving the message too quickly for you to write it down.
5 Read the message back to the caller to confirm the details.
6 Let the caller know that you will pass the message on.
7 Ask for a contact number if the caller wants a return phone call.
d Mr Henry is going to have a PICC line (Peripherally Inserted Central Catheter ) in

two days ’ time. He is having the special IV central line inserted because he has
been prescribed long - term IV antibiotics. PICC lines do not have to be replaced
every three days as standard cannulas do and so are more comfortable for the
patient and have fewer infection risks.
In pairs, practise giving and taking a telephone message. Student A , you are
a nurse from the IV Infusion Room; use the notes on page 93. Student B , you
are a Ward Nurse on Ward 16C ; use the message pad on page 88. Use the
guidelines for taking telephone messages. Swap roles and practise again .

1 In what other ways can messages be passed on ?
2 How are messages passed on to other staff members in your workplace?
3 What are some of the problems which can occur when messages have to
be passed on?

IV Prescription Chart
Checking IV orders
5 a In pairs, look at the chart and discuss the following questions.
1 What is this chart used for ?
THE ALEXANDRA HOSPITAL b

IV PRESCRIPTION CHART Name of Patient: Mabyn Hadfield
U/N: 62388
DRIP RATE CALCULATOR ( 1 Litre Bag) = Drops per Minuie (DPM) Microdrip sets (60 drops = 1ml/hr) ml/hr = Drops/min
Time (hrs) 2 4
.
DOB: 12.1 1920
6 8 10 12 16 18 24
Sex: Female
ml/hr ( 1 L bag) 500 250 166 125 100 83 62 55 42
20 drop/ml set 167 DPM 83 DPM 55 DPM 42 DPM 33 DPM 28 DPM 21 DPM 18 DPM 14 DPM
Fluids must be prescribed daily - only one bag will be administered against each order
Year: 2009 Medical Officer Prescription Nursing Administration Record
Date / Time Line Route Volume Fluid Type and Time to be Dr Signature Date Rate Nr 1 Time Volume
Additive infused Time ml/hr Nr 2 Stop Infused
start
30.05 /V 1000 ml Normal Saline 8 hours H.Khan 30.05 / 25 ml G.L 11.00 1000 ml
01.00 03.00 VA
50.05 /V 1000 ml 5X Dextrose 10 hours H.Khan 30.05 100 ml CA
08.00 11.00 KB
b Miss Mabyn Hadfield is an 89- year -old patient who was discovered on the
kitchen floor of her flat by her neighbours. She hod a fractured (broken) hip and
was very dehydrated.
7.5 Listen to a conversation between two Ward Nurses, Cheryl and Karen ,
1 Why does Cheryl ask Karen to watch Miss Hadfield’s IV ?
2 Why did Miss Hadfield have the IV infusion to KVO (to keep the vein open)
when she was admitted?
3 What IV solution does she have running at the moment ?
4 What does Cheryl ask Karen to do?
5 What do Cheryl and Karen check on the IV Prescription Chart?
6 What two things do the nurses check on the IV Infusion Bag?
7 What does Cheryl have to work out before she puts up the IV infusion ?
8 Who signs the IV Prescription Chart ?
9 What information do the nurses check which is not recorded on the IV
Prescription Chart ?

C ?.5 Cheryl and Karen talk about concentration percentages, volumes and
rates. Listen again and complete the following extract using the figures in
the box .
30th 03.00 1000 ml 5 % 16th 100 ml 5 % 8
11.00 10 1000 ml 2010
11.00 30th
*
Cheryl: That 's right. ( 1 ) _ litre of Normal Saline over (2) _ _ hours. It
went up at (3) _ hours and it’s through now at ( 4) hours so
I’ll write that in here. And I 'll write in the amount of (5) There.
Now we can check out the next one. The date is (6) of May, the
route is IV and the fluid is (7) Dextrose.
Karen: (8) , yes, IV, yes, (9) Dextrose, yes.
Cheryl: OK . We can check the IV infusion now. Here’s the bag. I ’ll just show you.
5% Dextrose. It expires on the (10) of July ( 11 )
Can you see the expiry date on the bag OK ?
Karen: Yeah. 5 % Dextrose, expires 16 th of July, 2010. Correct .
Cheryl: Right , so let me write it in. 30 th May, ( 1 2) hours. The rate is
one litre over ( 1 3) hours. That ’s easy to work out. One litre -
(14) divided by ten hours. That’s ( 15) an hour.
Charting fluid intake and output

When a patient is receiving IV therapy , it is important to keep an accurate
record of the patient’s fluid intake and output to avoid fluid overload.
6 3 In pairs, look at the chart on page 89 and discuss the following questions.
2 What is it used for ?
3 Who is responsible for filling out the chart ?
b Find abbreviations in the chart with the following meanings.

1 Large amount l e
^
2 Up to the toilet instead of using a bedpan or urinal so urine can be
measured
3 Has had a bowel movement; bowels opened
4 Carried forward (an amount from a previous chart)
5 Urine output
6 Water
7 Bowels not opened
8 Small amount
9 Wet bed one plus (small amount)
10 Orange juice
11 To keep the vein open (for example, to administer IV antibiotics)
1 2 Aspirate (of a naso- gastric tube)
13 Moderate amount

C Miss Stavel , whose chart is on page 89, has been receiving IV therapy post - op
after losing a lot of blood during an operation.
7.6 Listen to a conversation between two night nurses, Rebecca and
Casey, who are discussing Miss Stavel, and answer the following questions.
1 What specifically are Rebecca and Casey discussing?
2 What is the problem?
3 What other information will they use to assess Miss Stavel’s fluid status?
4 Circle the areas of the chart which the nurses are concerned about.
d w Rebecca and Casey discuss a number of inaccuracies in the Fluid
Balance Chart . Listen again and complete the following extracts using the
words in the box.
accuracy point inaccurately mistakes record
record recorded measure problem properly
1 There ’s no vecovA of any intake from 10 am to 5 pm.

2 And at 5 pm they _ the amount of water she drank
3 ... they haven't been able to it every time.

4 There s also
’ a with the of her urine output.
5 They can’t have been able to measure her urine output with any
6 ... there’s no adding up the intake and output because of the
e Read the audioscript on page 103 and find what Rebecca and Casey say to
point out the following inaccuracies.
1 The amounts of fluid held by hospital jugs and cups are not checked if there
is no calibration on the side of the jug or cup.
2 The procedure is not explained to the patient, so patient compliance with
the procedure is often poor.
3 Amounts are guessed instead of measured.

• Are Fluid Balance Charts used in your country ? If not, what is used to
record fluid intake and output?
• Have you experienced any problems with Fluid Balance Charts? If so,
what did you do about it?
• -I

UNIT 8 35 Pre- operative patient

1 What is your experience of pre-operative
(pre-op) checks?
2 Why are pre- op procedures important ?
3 What problems can occur if a pre- op check is not done accurately ?
b Nancy Clarke, a 58- year - old, is booked for elective bowel surgery . Last week ,
three polyps were discovered in her colon during a diagnostic colonoscopy
- the examination of the bowel through an endoscope. Alexandra, the Ward
Nurse, prepares Mrs Clarke for her operation by telling her about the pre-
operative routine.
8.1 Listen to the conversation and answer the following questions.
1 What pre -op hygiene instructions does the nurse give Mrs Clarke ?
2 Why isn't she allowed to eat or drink before the operation?
3 Why does she have to wear the stockings?
C 8.1 Listen again and complete the following sentences.

1 Yes. vn \-c look at the operation list
when it comes out later today ...
2 Now, get you to take off your nail polish later today ...
3 And . also need to shower with this antiseptic wash.
A my tummy be shaved before the operation?
5 ... for a few days, order you clear
fluids for today.
6 That means I be able to eat or drink anything after midnight,
I?
7 No, not at all. get you to take a special bowel preparation
drink later to clean out your bowel. also need a small
enema ...
62 Unit 8 Pre-operative patient assessment

d In pairs, practise explaining pre-operative preparations and asking
questions. Student A , you are a nurse; Student B, you are a pre-operative
patient. Swap roles and practise again.
Giving pre-operative patient education

2 a in pairs, discuss the following questions.
1 What is your experience of pre -operative patient education ?

2 Do you use different strategies when dealing with children or patients from
different cultural backgrounds ?
3 What are the benefits of pre- operative patient education,
both for patients
and for the healthcare system ?
b Match the medical terms ( 1- 5 ) to their meanings (a- e).

1 thrombus a the process of blood clotting
2 anti-embolic b deep vein thrombosis
c usually refers to a medication which inhibits the formation of
3 DVT
thromboses
4 anticoagulant d solid mass which forms in blood vessels; also called a blood dot
5 coagulation e stops an embolus from forming
C In pairs, read the post- op information sheet and the typical patient
questions ( 1- 7 ). Practise asking and answering the questions. Student
A , you are a patient; ask the questions. Student B, you are a nurse; find
answers to the questions using the information sheet . Swap roles and
practise again.
1 Is this something to do with clots?
2 How do I put the stockings on ?
3 Are they different from ordinary stockings ?
4 When do I have to start wearing them ?
5 I won’t have to wear these permanently. I hope?
6 Will I have to walk on my own ?
7 How long will I have to have the injections?
Post- operative instructions: mobilisation post- op

There are some important things which will be part of your post-operative recovery. You'll wear
anti- embolic stockings, mobilise gradually and be on anlicoagulant therapy. These measures are
important in order to prevent blood clots ( also called DVTs, or Deep Vein Thromboses ).
a Anti- embolic stockings

• Worn
Graduated compression stockings which provide varying pressure to your lower limbs
• two hours pre -op
and post -op
until you return
to full mobility
• Musi be put on smoothly ( no bunching of the stocking)
b Early ambulation
• You will be encouraged to gel moving again soon after your operation
• Frequenl short walks around the ward with assistance if necessary
c Anticoagulant therapy
• Subcutaneous injections of heparin twice a day
• Anticoagulant therapy continues until fully mobile
Unit 8 Pre- operative patient assessment 63

Preparing a patient for surgery
Research suggests that patients who are physically and psychologically prepared
for surgery tend to have better outcomes after surgery .

1 What would you talk to a patient about before surgery ?
2 Do you have any experience of working in a surgical ward?
3 What are the challenges of working in a surgical ward?
4 What changes have there been in abdominal surgery in recent years ?
5 How are patients prepared for abdominal surgery ?
b Match the medical terms ( 1-6) to their meanings (a- f).
1 gallbladder — a drug which blocks pain and other sensations before an operation is performed
b safety measure which prevents patients from continually obtaining analgesia by pressing a
2 laparoscope
patient-control button
3 anaesthetic c patient-controlled analgesia
4 PCA d surgical instrument which is inserted into the abdomen to visualise the abdominal organs
5 overdose e abdominal organ which stores bile
6 lock - out time f taking excess amounts of medication with serious health consequences
C In pairs, take turns to say a term and ask your partner to define it .
d Ms Emma Slade; a nervous 45 - year -old, is booked for an elective

cholecystectomy (removal of the gallbladder ) tomorrow.
8.2 Listen to Alva , the Ward Nurse, explaining what Emma can expect
when she returns to the ward after her operation , and answer the following
questions.
1 How is Emma feeling about her operation ?
2 What kind of surgery is she going to have ?
3 What is the name of the instrument the surgeon will use to visualise her
gallbladder ?
4 Why won 't she have a large scar after her operation?
5 How long will the mini- drain stay in after the operation ?
6 What will the nurses check before she can eat and drink after her operation?
7 When will the nurses remove her urinary catheter ?
e si Before Alva talks to Emma about her operation , she makes some notes to
’
help her remember everything she needs to say. Listen again and match Alva s
notes ( 1 -8) to her explanations (a-h).
a You’ll come back with an IV and some fluids running,
! No-fes Cor
I Keyhole surgery -
Slades
b
just until you can eat and drink again ,
It can be taken out when you 're back on the ward and
think you can void again - I mean, pass urine,
a 4-hree Or Pour c We check that you can swallow again by trying you with
.
pur c 4-ure Si-fes a few ice chips.
3 dreSSin
Sv^ ail d It ’s a small plastic container attached to some tubing
8 which takes away any excess blood from your wound,
4 drairi e ... also called minimally invasive surgery because it’s
5 IV - Ou4- u;h£vn ea+ mg *
performed with the use of a laparoscope, using small
av^d drinKin incisions or surgical cuts.
f These are just small holes made near your navel,
b shallow reQex - ice
g As soon as you can manage the ice chips, we’ll give you
Chips small sips of water.
7 SvJ Sips t-po h It’s just a light covering to keep the area clean until it
g IDC 4 uh£n PlA
Ou ~ heals.
Communication focus: allaying anxiety in a patient

1 What strategies have you used successfully to allay anxiety in a patient?
2 Would you use different strategies for different age groups?
3 What strategies might also be useful for a child ?
4 What strategies would you use for a patient who didn’t speak English?
b Complete the following strategies for allaying anxiety in a patient using the
words in the box .
involve rapport normal anxiety reassuring avoid
1 Establish a v- ppovf with the patient, as this helps to decrease the

^
feeling of depersonalisation and isolation .
2 Use a calm approach.
3 Explain that anxiety is a reaction.
4 Help identify situations which cause , for example fear of
anaesthesia.
5 Try to words which increase anxiety; for example, use
discomfort rather than pain.
6 Try to the patient in decision-making wherever possible, as
this decreases the sense of loss of control.

C s.S Listen to the rest of the conversation between Alva and Emma and
1 What concern does Emma have about using the PCA ?
2 What safety measure on the machine does Alva explain?
3 What will the nurses check frequently after the operation ?
4 How often will Emma use her tri-ball after the operation?
5 What do you think Alva’s second post-operative instruction might be?
d Alva used several strategies to allay anxiety in response to Emma’s concerns.

Match the concerns ( 1 - 5 ) to the responses (a- e) .
1 Is everything all right? There's nothing a No, not much, but I can make a note for
wrong, is there? the rest of the staff to cover the drain for
you so you don't see any of it.
.
2 I feel silly being so worried I'm not
b No, don't worry. We program the pump so
normally like this.
there's a Lock-out time.
3 There won't be lots of blood, will there? I
c No, not at all, everything's fine.
can't stand the sight of blood.
d That's OK, Emma. It's quite normal to feel
4 What about pain? I'm worried that I'll be a bit apprehensive.
.
in a lot of pain
e You'll have a PCA machine to use for any
5 But what if Ikeep pushing the button? discomfort after the operation. That's
Won't I give myself an overdose? what I wanted to show you .. .
6 In pairs, discuss which strategies Alva used when talking to Emma. Can you
think of any other strategies?
f Nashida Hussein , o 24 - year -old university student, has been admitted for an
elective appendicectomy . She is very anxious about the operation.
In pairs, practise allaying patient anxiety. Student A , you are Nashida ; read
the questions on page 90 and be ready to ask the nurse for the information
you need . Student B , you are the nurse; read the patient information sheet
on page 89 and be ready to answer Nashida’s questions. Remember to use
strategies to allay anxiety. Swap roles and practise again .

• Is patient education an important nursing focus in your country ?
• Have you been involved in patient education in your country? If so. what
did you find challenging about delivering patient education ? What did
you find rewarding?
66 Unit 8 Pre-operative patient assessment

Medical focus: blood circulation
5 3 In pairs, look at the picture and discuss the following questions.
1 What does the picture illustrate?
9 Do you have experience of caring for patients with this medical condition ?
b M Mr Vitellis, a 56- year- old teacher, has recently been hospitalised for
orthopaedic surgery following a skiing accident . Listen to a conversation
between Mr Vitellis and Nasreen, the Ward Nurse, and mark the following
statements True (T) or False (F).
1 Mr Vitellis underwent an orthopaedic operation which took several hours.
2 He showed no signs of having a blood clot after his operation.
3 His condition is being treated with anticoagulant medication.
A He had both anti-embolic stockings removed after the operation.
5 He has developed a pulmonary embolism.
6 He is free from pain and leaving the hospital today.
C Match the medical terms ( 1 - 5 ) to their meanings (a- e) .

1 venodilation a the condition which is caused when a blood dot blocks blood flow
2 embolus b the pooling of blood in the veins
3 embolism c stretching or widening of a vein
4 venous stasis d a blood clot which breaks off and moves freely along a blood vessel
d Underline the stressed syllable in words 1 - 4 .
e Label the following diagram using the words in the box.

embolism DVT normal blood flow embolus
1 4
••
</
I
v; .
#
t
f si Put the following stages of DVT in the correct order. Listen again and
check your answers to this and Exercise 5 e.
Formation of an embolus
Venous stasis caused by immobility
Blood becomes stickier and coagulates more easily
Venodilation causes small tears in the inner walls of the veins
An embolus blocks blood flow

g Complete the following explanations of the medication used to treat DVT,
using the words in the box .
warfarin pulmonary embolism filter anticoagulant
INR DVTs subcutaneous heparin lifelong dose
1 When a DVT forms in a patient’s leg, they are given

medication.
2 Most patients start treatment with whilst in hospital.
3 Heparin, an anticoagulant medication, is usually given as a
injection - that is, under the skin.
4 As well as heparin injections, patients start on the oral anticoagulant called
5 Patients will probably have to take the warfarin tablets for three to
six months after leaving hospital unless they’ve had problems with
or in the past. In these cases, they may require
warfarin therapy.
6 Warfarin therapy often requires frequent adjustment and
regular monitoring of the through a blood test.
7 If anticoagulant therapy is not effective or contra-indicated, the doctor may
talk to patients about having an IVC implanted.
h Mrs Heather Perry is taking the oral contraceptive pill and has recently
returned from a long -haul flight. Mrs Perry has two of the risk factors for
getting DVTs : hormone therapy , such as the oral contraceptive pill, and long
periods of sitting immobile, for example in a plane during a long flight. She has
been admitted to hospital with a suspected DVT in her right calf and is very
concerned about her condition.
In pairs, practise explaining how DVTs form , including some of the risk
factors, and the likely treatment plan . Student A , you are the nurse;
Student B , you are Heather Perry. Remember to use strategies to allay
anxiety in a patient . Swap roles and practise again .

Pre- operative Checklist
Doing pre- operative checks
Before a patient is transferred to the Operating Theatres, all relevant charts
and X -rays are gathered before a final ward check is made.
6 a In pairs, look at the chart on page 90 and discuss the following questions.
1 When is this chart used?
b 3.5 Viki, the Ward Nurse, is checking Belinda Mainwaring for surgery.
Listen to the conversation and complete the blue shaded parts of the
Pre- operative Checklist . Tick in the appropriate boxes marked YES or NO
or N/ A (Not Applicable).
68 Unit 8 Pre - operative patient assessment

C Patients pass from the care of one person to another several times on the way
to surgery , and pre -operative information is checked by various staff members.
Belinda is in the Operating Theatre holding area before she is taken in to have
her operation performed .
8.6 Wendy, the Theatre Nurse , checks the patient details and details
relating to the operation . She uses the green shaded area in the column
marked O / T (Operating Theatre) . Listen to the conversation and tick the
sections of the Checklist on page 90 that Wendy double-checks.
d 8.6 Listen again and put the following extracts in the correct order.
I know you’ve already answered many of these questions, but we like
to double -check everything.
I’ll sign the Checklist, and you’ve already got a theatre cap to cover
your hair.
D I’ll have a quick look at your identification bracelets if I may ?
Can you tell me your full name, please ?
Is this your signature on the consent form ?
Did you sign a consent form for the operation ?
[D I’m going to check you in today.
Have you had a pre- med?
I’m just going to go through this Checklist again. .
Can you tell me what operation you’re having today?
6 In pairs, practise going through the Pre-operative Checklist. Student A ,

you are the Theatre Nurse; Student B , you are the patient . Swap roles and
practise again.

1 What pre- operative procedures are you familiar with?
2 Are procedures different in your country ?
3 What are the benefits of having several checks before the patient has an
operation ?

UNIT 9 Post- operative patient
• Giving a post-operative
handover
• Checking a post- operative •> V ' ^ , ** V
• •<
fe
*• ,* .
*
patient on the ward •j • •v V • . >
»
«
*
V
V
.
• Explaining post-operative pain
• v • v• v• v•
V
* V
* V • V • • •> ** A * 4 V
V
* 4
•> *•> *•» * •* * •J v.

management > ;
I
:
* . * . l MI
* * •
• Dealing with aggressive V
behaviour
• Using pain assessment tools ft
*J
^ mil

1 What is your experience of post - op handovers?
2 What information and documentation needs to be passed on to the Ward
Nurse during the post -op handover ?
3 What sort of things does the Ward Nurse crosscheck when a patient comes
back from an operation ?
4 How is a post- op handover different from a change -of-shift handover ?
5 Why is it important to check the patient regularly after an operation?
b Roli Davidson , a 28 - year - old who has had surgery following a road traffic
accident (RTA), comes back to the ward. Hazel, the Recovery Nurse, hands Roli
over to Georgia, the Ward Nurse. Georgia conducts an initial return-to - ward
check and starts Roli on post - op observations.
9.1 Listen to the conversation and answer the following questions.
1 What operation has Roli just had ?
2 Why did the Recovery Nurses monitor Roli carefully after his operation ?
3 Why will Roli continue to receive IV fluids on the ward ?
4 Is Roll’s redivac draining properly ?
5 How did the surgeon close Roli’s wound?
6 Will the ward nurses have to re-dress Roli’s wound this evening?
7 Has Roli already had some pain relief?
8 Why did the Recovery Nurse give Roli an extra blanket ?
C Match the abbreviations ( 1 - 6 ) to their meanings (a — f).
1 RTA a Glasgow Coma Scale; records the conscious state of a patient

2 GCS -
b Non Adhesive Dressing
c measure of the amount of oxygen which is loaded or saturated into the red blood cells as
3 neuro obs. they pass through the lungs
4 oxygen sats / SaO? d from the Latin pro re nato : take whenever required
5 NAD e observations which assess neurological function and include a GCS assessment
6 prn f road traffic accident
70 Unit 9 Post-operative patient assessment
d s.l Listen again and fill in the missing information on Roli Davidson’s
Operation Report using the words and figures in the box.
oral redivac intact 36° dextrose 97 13/15
patent 72 clips NAD 75 ftTA
Name of patient Roli Davidson

Operation performed Splenectomy post (1) RT/\
CJCS before leaving Recovery (2 )
T (3) P (4) BP 112/64
Observations SaO -, ( 5) % on 3L/ min
IV therapy 1 L 5% (6)
Drains Redivac x 1 (7 ) and draining small amounts
Wound closure (8) x6
Wound Covered with (9)
Pethidine ( 10) mg IM 3° for 3 days then
Analgesia (11 ) analgesia
Remove ( 12) when draining < 20ml/ day
Post - op instructions Leave dressing (13 ) until surgeon's review
e In pairs, practise handing over a post-operative patient. Student A , you are a

Recovery Nurse; Student B , you are a Ward Nurse. Use the role card on page
91 . Swap roles and practise again.
Checking a post- operative patient on the ward

2 a
^
1
92 Listen to Georgia talking to Roli and answer the following questions.
Is Roli's temperature back to normal ?
2 What is the nurse going to get him for his sore throat ?
3 Does he feel like eating after his operation ?
4 Is he pain free at the moment ?
5 Has he been up to the toilet to pass urine ?
6 How can he call the nurse if he needs her ?
b s.Z Listen again and match the feelings ( 1 -8) to their explanations (a-h).
.
1 I'm still feeling cold Is that normal? a That's OK. It takes a little while to be orientated again after an
2 I'm awake now, butI still feel a bit anaesthetic.
groggy . b That's quite normal. Patients who've had abdominal surgery are often in
quite a bit of discomfort.
3 My throat feels really sore. It's hard
c Yeah, it's OK. It's called hypothermia. It happens sometimes if the
to swallow . operation takes a long time.
4 I feel like I'd be sick ifIate anything . d It's quite common to avoid any movement which might cause
5 I'm in bad pain, and everything hurts. discomfort, but it's important that I help you to move around and
change position.
6 I feel like I can't move because it's
going to be painful . e That's because you've had an anaesthetic .
f It's quite usual to have that sensation, even though you've got a
7 I feel as if I want to go to the toilet all catheter in your bladder.
the time. g Nausea is sometimes a reaction to post - operative pain.
8 I feel dizzy, too. It's like I'm going to h Don't worry, that's normal. It's just caused by the tube they put down
fall out of bed . your throat during surgery .
C In pairs, practise expressing feelings and explaining the cause. Student A , you
are Georgia; Student B , you are Roli . Use Exercise 2b and your own ideas.
Swap roles and practise again.
Unit 9 Post-operative patient assessment 71
Explaining post- operative pain management
3 a Paul Vargas was the victim of an assault and sustained a fractured zygoma
(broken cheekbone) and multiple lacerations (cuts) to his arms and chest. After
surgery he is in pain and requires careful pain management.
9.3 Listen to a conversation between Paul and Patricia, the Ward Nurse, and
1 How does Paul rate his pain?
2 Why has he been ordered paracetamol ?
5 What does the nurse do to help him sleep?
b Paul describes his pain to Patricia. Complete the following sentences using
the words in the box. Can you think of any other ways to describe pain?
hurts throbbing hurt knife stinging
1 My arms where the cuts are.

2 I’ve got a headache.
5 My right cheek when I touch it.
4 It’s a pain in the shallow cuts.
5 This cut in my chest is quite deep, and the pain’s like a
C -
9.3 Listen again and match Patricia ’s questions ( 1 8) to Paul’s answers (a-h).
1 How are you feeling now? ^

a Yeah. My head, my cheek ... urn, the broken cheek, I mean .. .
2 Can you tell me where the pain is? b It's a stinging pain in the shallow cuts, but this cut in my chest is
3 Can you tell me if the pain is the same all quite deep, and the pain's like a knife,
over or different? c Oh, not too good. Everything hurts,
4 What about the pain in your arms and d It gets worse. Seven, at least.
chest? e One of the nurses gave me a heat pack for my chest, and that
5 When's the pain worse, Paul? helped.
6 What's the pain like now you are at rest? f I've got a throbbing headache, and my right cheek hurts when I
7 And when you move a bit? touch it.
8 Is there anything else which relieves the g It's worse when I turn over or move,
pain? h It's around six.
d In pairs, practise rating pain and explaining how to manage pain. Student
A , you are a patient in severe pain after a car accident and have multiple
fractures and lacerations. Student B, you are the Ward Nurse; ask the patient
to rate the pain level on the pain scale and explain to them how to manage
the pain. Swap roles and practise again.

1 What other words can describe pain?
2 What kind of pain could each of these words describe?
aching cramping crushing throbbing radiating
5 What are some examples of pain behaviours that chronic pain sufferers
might exhibit ?
4 Why might chronic pain sufferers exhibit these behaviours?
5 Have you had experience of caring for a patient with chronic pain ? Did
you encounter any difficulties with his/her pain management ?
72 Unit 9 Post -operative patient assessment

Dealing with aggressive behaviour Aggressive Behaviour
The hospital environment is often stressful for relatives Management (ABM)
and friends of patients, especially when they witness Techniques
a loved one in pain. Sometimes, tense situations can
develop into aggressive behaviour towards staff members. Alt staff are to follow these guidelines
to avoid the escalation of
violence in the
workplace. Aggressive behaviour towards J1
• orHaveviolent
you had any experience of dealing with aggressive staff will not be tolerated and will be dealt
individuals in a healthcare environment ? with by security if necessary.
• What strategies can you use to calm the situation?
b ABM Guidelines
‘M Listen to a conversation between Patricia and observe a potentially
Bev, another Ward Nurse, and answer the following • aggressive
(i)
situation and attempt to
questions.
(2) it before things
1 Why are the nurses staying at the Nurses’ Station?
get out of hand.
2 Why is Paul ’s visitor, Mr Fellows, angry? calmly to what
3 How do the nurses react to him ? • (the
3) —
patient or visitor is trying to tell
4 What does the nurse ask him to do so she can
you.
understand him?
in a quiet but firm
5 How does the nurse reassure him about Paul? • - j)
(4
%
tone in order to calm the situation .

C Many hospitals have Aggressive Behaviour Management
(ABM ) protocols which are followed when dealing with
• or visitor
— tells
(5) what the patient
you to demonstrate
patients or visitors. your understanding.
by indicating that
Complete the staff information sheet on the right • (you
6)
can understand why they are
using the words in the box .
upset.
solution listen defuse speak observe empathise to the
alternative rephrase • Offer a (7)
problem or an (8) - if a
solution is not possible.
d In pairs, read the audioscript on page 106 and find
examples of the ABM techniques that the nurses used
with Mr Fellows.
e Mrs Charmaine Berry has arrived at Neurology after a long wait in A&E. She is
complaining of a severe migraine which she has rated as an 8 on the pain scale,
despite receiving analgesia. The doctor has been paged but, unfortunately ,
has been delayed by an emergency . Mr Berry is becoming visibly agitated by
his wife's pain and has approached a nurse on the ward to demand immediate
attention for his wife.
In pairs, practise defusing a tense situation. Student A , you are the nurse;
Student B , you are Mr Berry. Swap roles and practise again.

1 Is aggressive or violent behaviour towards nursing staff a problem in your
country?
2 What do you think are the reasons behind this type of behaviour ?
3 What initiatives would you like to see taken to address this serious issue ?
Unit 9 Post-operative patient assessment 73

Medical focus: pain receptors
Post -operative pain is experienced at different levels, depending on the extent
of surgical trauma. The type of surgery , the patient's preparation for surgery
and the patient ’s previous experience of surgery also play a part in pain
tolerance.
5 a Read the patient information leaflet and answer the following questions.
1 Where does cutaneous pain originate from ?
2 What is the pain which originates in body organs called?
3 What are the two types of pain fibre called ?
4 What is the difference between fast and slow pain ?
5 What is a common term for analgesia ?
Post-operative pain management

The two types of pain which you may experience in the
post-operative setting are called cutaneous and visceral
pain. After a surgical incision, pain-causing substances are
released.These chemical substances cause cutaneous
nociceptors, or free nerve endings, to detect the injury
to the skin.This is known as ‘fast pain’ and is sharp or
acute. It is also localised pain, meaning it is only felt in the
spinal cord
area of the injury. Nociceptors transmit impulses using
afferent nerves (nerves which carry impulses towards
the central nervous system) through Type A -delta fibres. hom
The fast, sharp pain impulses travel via peripheral nerves
to the dorsal horn at the back of the spinal cord. Here
they synapse, or connect, with the second type of fibres .
Type C fibres.Type C fibres detect visceral pain.Visceral V
nociceptors are found in all the organs of the body and detect pain
impulses as slow, aching pain. Slow pain is also described as referred nerve
pain - that is, pain which is felt in a different part of the body from
the original injury. In the dorsal horn, Type A -delta and Type C fibres
skin
synapse with dendrites in the spinal cord (extensions of the nerve
/
cell body that receive signals from other nerve cells) and travel up the
spine as neurons or nerve impulses.They then ascend to the midbrain
i
where the nerve impulses are processed and are transmitted back
to the body as a pain signal.The type of pain, cutaneous or visceral,
determines the choice of analgesia, or pain relief, that you will be given for your post- operative pain.
b Match the medical terms ( 1 - 6) to their meanings (a-f ) .
1 nociceptor a relating to the skin

2 cutaneous b a cut into the skin; often refers to a surgical cut
3 visceral c a pain which is felt in a part of the body away from the injury site
4 incision d referring to the internal organs of the body
5 localised pain a receptor which detects painful stimuli
6 referred pain f pain which is felt around the site of an injury
C Underline the stressed syllable in words 1 -6.
74 Unit 9 Post- operative patient assessment

d si Listen to Sonia, the hospital Pharmacist, talking about post operative -
analgesia. Match the medical terms ( 1 -9) to their meanings (a i) . -
1 pain threshold a medication which is given in between doses where more pain relief is needed
2 pain tolerance b a medication which brings down a high temperature
3 NSAIDs c the most pain which a person can put up with
4 opioids d opiate proteins with pain-relieving properties which occur naturally in the brain
5 endorphins e treatment which combines several types of pain management
6 anti- pyretic ^ f level of stimulation required before pain felt
7 background drug g drugs which produce a morphine- like effect
8 multimodal h non - steroid anti-inflammatory drugs; also called non-steroidats
9 breakthrough dose
i a drug used to support the main analgesic; often used to reduce the amount needed of
opioid medication
G
^.9.5 Listen again and complete the following notes using the words in the
box
multimodal threshold non-steroidals background scale tolerance
actrte morphine- like
Post-operative pain is ( 1 ) <?\ CIAfe

pain
Pain ( 2) - point at which everyone experiences something
as painful
Pam (3) _ - subjective, different experience for each patient
Pam (H ) _ - used to assess individual pain level
Surgical incision causes localised pain - ( 5 ) , anti -
in /lammatory drugs most effective
Visceral pain causes referred pain - opioids or (Q drugs
most effective
Drugs such as paracetamol are added as (1) drugs to
reduce amount of opioids needed
(& ) treatment - when different kinds of treatmenl are
used at the same time
f In groups of three, look at the audioscript on page 106. Student A , make

notes on the use of opioids; Student B, make notes on the use of non-
steroidals; Student C, make notes on the use of paracetamol. Using only your
notes, take it in turns to explain your topic. Be prepared to answer questions
from the group.

1What can happen if pain remains untreated or is not dealt with
sympathetically ?
2 Do you think pain is experienced differently in different cultures?
3 Do you have any experience of different pain responses because of
.
cultural background? If so how did you help your patient deal with his/
her pain?
Unit 9 Post- operative patient assessment 75

Charting and documentation: pain assessment
6 3 In pairs, look at the chart on page 91 and answer the following questions.
1 What is this chart for ?
3 What is the scale that uses diagrams of different facial expressions called?
4 What other types of rating scale are found on this chart ?
5 Why do you think these types of assessment chart are important ?
b Six - year -old Anton had a tonsillectomy yesterday. The Ward Nurse, Sharon, talks to
him and his mother, Sarah, about pain relief. Sharon is wearing a large badge with
her name on and a picture of a friendly cartoon character.
9.6 Sharon explains the Wong- Baker faces to Anton and Sarah. Listen to the
conversation and answer the following questions.
1 What does Anton get as a reward after his medication ?
2 Which face does he point to?
3 What does the nurse get him to play with ?
C Listen again and match the description of the faces in the chart ( 1 - 6) to
Sharon ’s explanations (a- f).
1 Face number 1: no pain • a He's got quite a lot of pain. It hurts when he moves about.
2 Face number 2: mild pain which can be ignored

b Can you see that he looks really unhappy ? He's got a frown on
his face, and he can't concentrate on anything.
3 Face number 3: moderate pain which interferes c This poor guy's crying and can't even get out of bed because it
with tasks 1 hurts so much. It's the worst pain he's ever felt.
4 Face number 4: moderate pain which interferes
^d Can you see he's smiling? He feels great. Nothing hurts.
with concentration
5 Face number 5: severe pain which interferes e And the next little fellow's feeling worse. The pain's very bad
with basic needs .
now He's feeling very bad.
6 Face number 6: worst pain possible, bed rest f The next face feels pretty good, but it hurts a little bit. He can
required put up with it.
d Sharon and Sarah use question tags when they speak to Anton . Complete the
following sentences using the question tags in the box . Why do you think they
use question tags?
isn't he? doesn't it? shall we? don't you? is he ?
1 I think Anton likes the stickers I give him after his medicine even better,
2 He’s starting to look a bit sad,

3 He’s not very happy at all,
4 Playing games always takes your mind off feeling uncomfortable,
5 We ll let mum go and have a cup of coffee,
76 Unit 9 Post- operative patient assessment

( 1- 7 ). Have you
e In pairs, look at the strategies for dealing with a child in pain
used any of these before ?
1 Try to form a relationship with the child by using inclusive language
.
first name and introduce yourself to the child.
2 Wear a name badge with your
3 Use a soothing , reassuring voice .
4 Use appropriate language for any explanations.
5 Use humour to relax an otherwise tense situation.
pain.
6 Reassure the child that you will help them to feel better and reduce their
7 Use therapeutic games to take the child’s attention off the pain.
f Match the sentences from the conversation (a-g) to a strategy in

Exercise 6e ( 1- 7 ).
a It ’s Sharon. She’s got that name badge on that you like. 2.
b I think Anton likes the stickers I give him after his medicine even better, don’t
you?
c Mm, still hurts to talk , doesn’t it, Anton ?
kids who
d I’m going to show you my sad and happy faces. They re very useful for
'
can ’ t talk because they’ ve got a sore throat,
how you
e Now, Anton, can you help me by pointing to the face which is showing
feel right now?
you to
f I’m going to get you some medicine to help your sore throat , but I want
tell me first how much it hurts.
, doesn ’ t it?
g Playing games always takes your mind off feeling uncomfortable
g In pairs, discuss the following questions.

-
• What other strategies have you used successfully to distract a child from post
operative pain?
• Which strategies have not been successful ?
• Have you ever had any difficulties pacifying a child in pain?
Lucas , a 7 - year -old. has had a repair of an inguinal hernia this morning .
His
h
father, Anthony , has ashed for some pain relief for his son.
In pairs, practise explaining and using the Wong- Baker faces chart
. Student
you are a Ward Nurse ; Student B , you are Lucas . Swap roles and practise
A,
again.

your
group ’s ideas to the class.
1 Which other groups of people might the Wong-Baker faces chart
be
useful for ?
visually
2 How might you adapt the Wong-Baker faces chart for a young
impaired patient?
3 How might the Wong-Baker faces chart be adapted to assess other
problems patients may have?
Unit 9 Post- operative patient assessment 77

UNIT 10
• Attending the ward team
meeting
• Telephone skills: referring a
patient
• Explaining the effects of a
stroke
• Using patient discharge
planning forms
Attending the ward team meeting

Most hospital wards have a weekly team meeting to
discuss the progress of certain patients. The members of the
team involved in the patient’s care meet to talk about care
after discharge from hospital , and plan any assistance which
may be needed.
l a i n pairs, discuss the following questions.

Why is collaboration between healthcare professionals important
?
1
occur during team meetings ?
2 What are some of the difficulties that might
3 What is your experience of ward team meetings ?
Lidia, an
b Andrea , a Rehab Ward Sister, is chairing a team meeting to discuss
80 - year -old patient who has recently suffered a stroke. After a period of
rehabilitation in hospital she is now ready for discharge .
lO.I Listen to the meeting and mark the following statements True (T) or
False (F).
1 Lidia has always been very independent.
2 Her daughters found her unconscious.
3 She had been drinking and was slurring her speech.
4 She had a stroke while they were visiting her.
5 She will need help with her ADLs.
6 The Occupational Therapist team have done a home assessment.
7 She still has difficulty with her speech.
C lO.I Listen again and answer the following questions.
1 How long has Lidia been in hospital?
2 What is her main goal ?
3 What day is the home assessment booked for ?
4 What special arrangements were made regarding her food?
5 Where is she going to stay when she first gets out of hospital?
6 When is her expected date of discharge ?
78 Unit 10 Discharge planning
d Match the phrases ( 1 - 6) to the functions in a meeting (a-c ).
1 Let's start with ... - a Managing the meeting

2 The purpose of this meeting is ...
3 William, do you want to kick off ?
b Including/inviting other people in/into the discussion
4 Iagree with both of you .
5 Yes, I'm a bit worried about that as well .
6 Tina, what about ... c Agreeing with colleagues
6 Mr Eddie Trumpett , a 55- year- old stroke victim , is going home to his wife
and two teenage children. In groups of four, practise taking part in a team
meeting. Student A , you are a Nurse; Student B, you are a Speech and
Language Therapist; Student C, you are a Physiotherapist; Student D, you
are a Doctor. Remember to use the phrases from Exercise 1 d.
Telephone skills: referring a patient

2 a Ward staff often need to make telephone referrals to allied health
departments or services. In pairs, look at the telephone referral form
below and discuss the following questions.
1 Who referred Lidia to the District Nursing Service?
2 Where was she referred from?
3 Who is her next of kin ?
I
TELEPHONE REFERRAL FORM
Service referred to District Nursing Service

Name of patient Lidia ( 1) Vassily
Address ZH Spring Lane , Cxeter
Entry to home
(circle)
Phone number
Digital Code / e )
^^
If by key, name of carer with spare key: ( 2)
( 3)
GP Ur Serena (4)
Referred by Andrea Dubois 0<<N )
Place of referral Alexandra Hospital
Diagnosis - -sided weakness , difficulty swallowing
Stroke, mod. left
Assistance with ADLs ( circle) (5) bathing mobility nutrition
( 6) normal soft diabetic
Diet (circle)
Other requirements (cultural/religious)
Delivery of meals (circle) ( 7) Yes / No
Home assessment booked (8) Yes/No

(circle) If Yes, date booked:(9)
Aids / Equipment walking frame shower chair oxygen nebuliser
(circle if need to be ordered)
Next of kin Larissa ( daughter )
0 / 2 5 181 991
Phone number:
^
b lOi Andrea , the Ward Nurse, rings Nadine, the District Nurse, to discuss
Lidia ’s referral to the District Nursing Service. Listen to the conversation
and complete the sections of the referral form marked 1 - 9.
Unit 10 Discharge planning 79

C Speaking on the telephone to fluent speakers is often particularly difficult
when under pressure. In pairs, discuss the following questions.
1 Have you had difficulties with telephone communication ?
2 What types of situation have you found challenging?
3 Which of the following strategies for effective telephone communication have
you used ?
Strategies for effective telephone communication

Ask the fluent speaker to slow down as soon as you have difficulty
understanding.
.
Don't wait to ask the speaker to slow down until you are really lost
When you are taking down important details, repeat the information back
so that you are sure you have understood.
Do not be embarrassed to ask more than once if you are still not sure.
d lO.Z Listen to the telephone conversation again and tick the sentences you
hear. You may hear both sentences in each pair.
1 a I’m sorry. What was your name again, please?
b Sorry, what was your name ?
2 a Could you please spell that for me?
b Can you spell it ?
3 a Can you say that again, please ?
b Could you please repeat that? I didn’t catch the last numbers.
4 a Sorry, I didn’t catch that.
b Would you mind speakinga little slower, please? I’m having trouble
following you.
e In pairs, practise making a referral for district nursing services. Student A ,

you are a Ward Nurse; Student B, you are a District Nurse. Use the referral
form on page 79 and Mr Vogel’s notes on page 91 . Remember to use
effective telephone strategies. Swap roles and practise again .
f Nurses often have to handle patient enquiries over the phone. It is important
to assist the caller as much as possible whilst remembering to respect patient
confidentiality at all times. Mr Bouchard had a fall at home and has been in
hospital for four weeks after suffering a stroke. His daughter, Gillian, phones
the Ward Nurse, Simon, for some advice.
l0.3 Listen to the conversation and answer the following questions.
1 What can happen to a person’s emotional state after a stroke?
2 Who will Simon ask to call Gillian?
3 Why can ' t Simon discuss Mr Bouchard’s progress with Gillian ?
4 Who does he suggest Gillian speak to and why?

g In pairs, discuss the following concerns that patients have when they call a
hospital. Have you dealt with callers who had any of these concerns?
1 Callers sometimes feel they are a nuisance.
2 Callers do not know the title or rank of the person they are speaking to.
3 Callers are concerned they will be cut off or not directed to the correct
department.
A Callers worry that they will not be taken seriously.
5 Callers worry that their concern will not be dealt with efficiently.
6 Callers don’ t know what information they can request and
what is
confidential.
h KU Listen again and match the concerns in Exercise 2

g ( 1- 6 ) to what
Simon says to address the concern (a-f).
a I’ ll make a note in Mr Bouchard’s notes and pass the message
on to his Key
Worker. ^
b I can understand why you're concerned.
c I'm afraid I can ’ t talk to you about your father ’s results because of
confidentiality.
d I’m a Staff Nurse on this ward.
e Not at all. I’m happy to help you if I can.
f I ’ll give you his direct number in case I can’t put you through.
1 In pairs, practise Gillian and

Simon’s telephone call using
the following prompts. Swap
G : Ask to speak to nurse
S. Confirm that you are looking
after patient
G: Concerned about father 's
moods
S: Express understanding / pass
information to Key Worker
G: Ask for test results
S: Decline / patient
confidentiality / details of
Discharge Planning Nurse

1 Do you have the same privacy rules regarding patient information in your
country?
2 How else are patient records kept confidential ?

Medical Focus: cerebrovascular accidents
The extent of the damage caused during a cerebrovascular accident (CVA), or
stroke, depends on the area of the brain which is affected.

1 What damage is caused to the body by CVA , or stroke?
2 What are some of the long- term problems of stroke ?
3 Have you had experience of nursing a patient who has suffered a stroke?
b Match the medical terms ( 1- 7 ) to their meanings (a-g) .

a type of stroke caused when a thrombus blocks the carotid artery, resulting
1 hemisphere
in ischaemia and tissue necrosis; the most common type of stroke
2 carotid artery b area underneath the brain where the cerebral arteries are linked
3 Circle of Willis c cerebrovascular accident, or stroke; cerebro means brain
d type of stroke caused when a blood vessel bursts causing blood to leak
4 ischaemia
into the brain; causes around one fifth of strokes
e inadequate blood supply caused by a blockage in the blood vessel; isch
5 CVA
means deficiency or lack of
6 ischaemic stroke f either of the two arteries which supply blood to the brain
7 haemorrhagic stroke g one of the two regions of the brain; hemi means half
C Underline the stressed syllable in words 1- 7 .
d Complete the following text describing an ischaemic stroke using the words
and phrases in the box.
branch out oxygenated obstruct 60% haemorrhagic deprived of cerebral hemispheres
Ischaemic stroke is the most commonly occurring stroke: ( 1 ) tot of all strokes.
(2) stroke is less common: 20% of all strokes.
Regions of the brain: the brain is

divided into two ( 3) , or parts.
4¥ m
The Circle of Willis allows blood to
(4) and reach the entire brain. t?
c \
The left and right carotid arteries supply

^
(5) blood to the brain.
Ischaemia results from a blockage in a

( 6) blood vessel and causes the
brain to be ( 7) oxygen and
important nutrients.
Thrombi which lodge in any of the blood vessels of the brain may (8) blood flow.
Explaining the effects of a stroke
4 a 10.4 Eric Sloane, a 76- year-old retired railway worker, has just suffered
a stroke. Katherine, the Ward Nurse, talks to his son and daughter about
what happens in ischaemic stroke. Listen to the conversation and mark the
following statements True (T) or False (F) .
1 A left CVA ischaemia causes tissue death on the left side of the brain but
affects the right side of the body.
2 Mr Sloane has difficulty swallowing because of weakness around the mouth.
3 He is very happy and laughs a lot.
4 A left CVA can cause speech problems.
5 It is important to be patient when you talk to someone who has
had a stroke,
because they can ' t hear properly.
b Match the medical terms ( 1 -8) to their meanings (a- h) .
1 hemiparesis
a motor speech impairment which affects the ability to form
words clearly
2 hemiplegia b difficulty swallowing food or fluids
3 hemianopia c inappropriate emotional responses, for example laughing
when the intention is to cry
4 aphasia d difficulty expressing what you are thinking
5 dysphasia e weakness on one side of the body
6 dysphagia f paralysis on one side of the body
7 dysarthria g defective vision on one half of the body leads to neglect of
one side of the body
8 emotional lability h inability to communicate
C Underline the stressed syllable in words 1 -8 .
d In pairs, practise explaining the effects of a stroke. Student A, use the Patient
Profile on page 91 ; Student B , use the Patient Profile on page 93 . Read the
text on Right CVA below to help you . Be prepared to answer any questions
your partner has. Swap roles and practise again.
RIGHT CVA
The causes of right CVA are the same as for left CVA.Tissue death on the right side of the brain
results in damage to functions on the left side of the body. It may cause left hemiparesis, or left-
sided weakness, and in more serious cases left hemiplegia - left- sided paralysis. A person with
right CVA can also have dysphagia - difficulty swallowing - or dysarthria - difficulty articulating
or pronouncing words. Damage to the right side of the brain causes vision problems instead of
speech and language problems caused by damage to the left side.Patients with a right CVA may
have visual problems like hemianopia, or defective vision, on the right side of the body, making it
difficult for them to judge space and distance.They may also neglect the weaker side of the body
and ignore objects which are on their left side, meaning that they can fall quite easily.This can be
dangerous, especially as people with right CVA tend to behave in an impulsive way, as they are not
aware of the extent of the injury to the brain. Short-term memory loss is also a problem.

Charting and documentation: Katz AOL Index
5 3 In pairs, look at the chart and answer the following questions.
1 What is this chart used for ?
2 What sort of patient would this chart be useful for ?
3 What type of patient might score six ?
4 What type of patient might score one?
U/ N: 478261 Surname: Given names: DOB: 12.01.1930

ACTIVITIES INDEPENDENCE DEPENDENCE
POINTS (1 ORO) (1 POINT ) (0 POINTS)
NO supervision, direction or personal assistance WITH (f ) direction, personal assistance
or total care
BATHING ( 1 POINT ) Bathes self completely or needs help in ( 0 POINTS) Needs help with bathing more than
POINTS:- bathing only a single part of the body such as the one part of the body, getting in or out of the tub
back, genital area or disabled extremity. or shower. Requires total bathing.
DRESSING ( 1 POINT ) Gets clothes from closets and drawers (0 POINTS) Needs help with dressing self or needs
POINTS: and puts on clothes and outer garments complete to be completely dressed.
with (a) . May have help tying shoes.
TOILETING ( 1 POINT ) Goes to toilet, gets on and off toilet, ( 0 POINTS) Needs help to transfer to the toilet,
POINTS: arranges clothes, cleans genital area without help. cleaning self, or uses bedpan or (g)
TRANSFERRING ( 1 POINT ) Moves in and out of bed or chair (0 POINTS) Needs help in moving from bed to
POINTS: unassisted, ( b) are acceptable . chair or requires a complete ( h)
FEEDING ( 1 POINT ) Gets food from plate into mouth (0 POINTS) Needs partial or total help with feeding
POINTS: without help. Preparation of food may be done by or requires (i) feeding.
another person.
CONTINENCE ( 1 POINT ) ( c) _ : exercises complete self - (0 POINTS) Is partially or totally (j) of
POINTS: control over (d) and (e) bowel or bladder.
TOTAL POINTS 6 = HIGH patient independent
0 = LOW patient very dependent
b Match the terms ( 1 -10) to their meanings (a- j).

1 fasteners a the act of passing faeces
2 mechanical transferring aids b devices which join two pieces of clothing together; for example, buttons
3 parenteral c a chair which contains a bedpan under the seat
4 continent d watching a patient to ensure an action is performed safely
5 transfer
e administered in any other form but orally, for example by injection or through a
feeding tube
6 commode f not having control of bladder or bowel
7 supervision g to move from one place to another, for example from bed to chair
8 defecation h the act of passing urine; also called micturition
9 incontinent i having control of bladder and bowel
10 urination j mechanical devices used to transfer disabled patients; for example, hoists or
sit-to- stand lifters
C Complete the gaps in the Katz Index in Exercise 5 a (a- j) using the terms
from Exercise 4b.

d Mrs Ernesto Bortoli is in a medical ward after suffering a stroke. She is going
to be transferred to a care home as she can no longer remain in her own home.
Deanna Giles, the Ward Nurse, is telephoning The Pines care home to hand over
information about Ernesta’s ADL score.
l0.5 Listen to the conversation and complete the Katz ADL Index in Exercise
5 a using her scores. How much assistance will she need?
6 In pairs, look at the chart on page 92 and discuss the following questions.
1 What is assessed using this chart and when is it used?
2 Have you used a chart like this before?
3 Why is it important to note the estimated date of discharge (EDD) ?
4 What is a Dosette Box ?
5 What can happen if community services are not arranged before patients
return home?
6 Why is it important to note the digital door code or the whereabouts of a key ?
7 What is a multi-disciplinary team (MDT]?
8 Why is it important to interface with the multi-disciplinary team ?
9 Why is it important to discuss discharge plans with the patient or carer?
f Henry Jacques is an 80 - year -old preparing to return home after a total hip
.
replacement. He is a little hard of hearing and uses a hearing aid . His daughter
Stephanie, lives nearby and has a key to his bungalow. She will be available to
pick up Mr Jacques when he is ready for discharge. He is very independent but
will need some equipment to help him mobilise (a walking frame) and to help with
safety in the shower (a shower chair). He will also need a Dosette Box arranged
so that he can manage his medications at home. Stephanie leaves him enough
prepared meals in the freezer for the week and Henry always goes to Stephanie’s
for Sunday lunch. Mr Jacques still has a small wound dressing which will be seen
to by the District Nurses .
in pairs, use the chart on page 92 to interview Mr Jacques about his

discharge planning needs. Student A , you are the Discharge Planning Nurse;
Student B, you are Mr Jacques. Complete all relevant parts of the chart .
Remember to speak clearly and check for understanding. Use active listening
strategies to show Mr Jacques you are interested in what he has to say. Swap

• What assessment tools do you use in your country when transferring
patients from a hospital to another healthcare facility?
• What are these assessment tools used for?
• Can this process be made more efficient with the use of technology ?

ROLE PLAYS AND
ADDITIONAL MATERIAL err: •in
Unit 1
Patient details
Full name Margaret Blake
DOB 16 October 1935
Reason for admission review of a venous ulcer
Past medical history IDDM (insulin -dependent diabetes mellitus)
HT (hypertension) Ml four months ago
Past surgical history femoral-popliteal bypass four months ago
Medication insulin,half an aspirin and a multivitamin
Allergies penicillin and codeine
Next of kin Judy Simpson
5 h
THE ALEXANDRA HOSPITAL P U/N:619237
Surname:Cummins
Given names:Fred
PATIENT RECORD DOB: 17.02.1955
DATE & TIME Add signature, printed name, staff category,date and time to all entries
20.5.2008 AV Cummins was hypertensive this am BP elevated to 180 / 100 and

15.30hrs. P 8t> at lO.OOhrs. do headache. Pt . stated he had no chest pain. Given
paracetamol Ig with cjood effect. Headache relieved. BP checked at
10.30hrs. BP decreased to 150/ 85, P 77.
5 Stottle ( PN ) STOTTLE
6 a/ c
THE ALEXANDRA HOSPITAL P U/N: 324710
Surname: Small
Given names: Gladys
OBSERVATION CHART DOB: 15.11.1935
Date Time T P R BP Comments Sign name

9 / 3 / 08 0Z00 3Q 8C
18 115 / 101 J . Plant ( PN )
9 / 3 /08 0600 3(2 15
18 115 / 95 J . Plant ( PN )
9/3/08 J000 36) /00 20 210/120 J Hardcast/e (PN)
9/3/08 1900 3Q 95 18 185/90 J. Hardcast/e (PN)
9/3/08 1500 3c 16 170/85 J. Hardcastfe (PN)
Unit 2
6 e Student A
You are working with a colleague on the evening shift. You have both read Mrs Oondahi's
notes. Ask and answer questions about Mrs Oondahi's respiratory status using the prompts.
respiratory rate / at the moment? how?
how much oxygen ? morphine?
86 Role plays and additional material

THE ALEXANDRA HOSPITAL y U/ N: 593712
Surname: Castle
Given names: Rebecca
OBSERVATION CHART DOB: 15.9.1922 Sex: Female
Date Time T P RR BP Pain Comments Sign name

Him 06.00 3Q 72 16 / / 0/70 0 / 10 Al Fotter CRN )
HZ09 01.00 X 16 IS 105 /65 0 / 10 Al Potter CRN )
HZ09 08.00 OT
HZ09 09.00 OT
HZ 09 10.00 OT
HZ09 11.00 OT
HZ09 / ZOO OT
HZ09 13.00 OT
HZ09 1 H.00 362 IS 22 no /15 6 / 10 RTW on VGA Fentany ! Al Potter ( RN )
HZ09 15.00 3Q 16 IS 115 / 65 H / 10 PGA Fentanyl AV Potter ( RN )
HZ09 16.00
Unit 4
3 g Mr Jim Dunston, a 38-year-old self -employed man has been admitted to the Diabetic Unit for
treatment of an ulcer on the underside of his left foot and for a review of his insulin. He is a keen
fisherman who often goes rock fishing. During a recent fishing trip, while walking barefoot, he
.
trod on some sharp pieces of rock, injuring his foot The wound has been very Slow to
heal and
.
is now infected He has signs of poor circulation and hypertension. Mr Dunston goes to the local
club for a meal most days and tends to have a high intake of alcohol .
Unit 6
PATIENT'S NAME: Airs Elisha Gupta U/N: 7735%
MORNING (around 08.00); MIDDAY ( between 12.00 &14.00); EVENING (around 18.00); BEDTIME (around 22.00)
Enter dose against time required. Use REGULAR MEDICATIONS MONTH Atoy YEAR ZOOS
only one route for each entry. 95 5.5 7.5
65 55 95 10.5
- -
Date > 95 MEDICINE (Approved Name) SPECIAL INSTRUCTIONS PRESCRIBER 'S Pharmacist
Routed
P<> Furosemide
SIGNATURE S.Neuj4-oo
Specify time Dose F I1rankston
Supply
required ZOrnq Dose
+ +
*
Morning 0500
change Bleep no: 5690
‘Orny
•T
Midday 1200 90mg

Evening
Bedtime
NON- ADMINISTRATION CODE: X Doctor 's request 2. Patient not -on ward 3. Unable / No access
4. Refused 5. Medication not available 6. See notes
Role plays and additional material 87

7 a PATIENT'S NAMF - Afr David Albiston U/N: ? 13357
MORNING (around 08.00); MIDDAY (between 12.00 &14.00);EVENING (around 18.00); BEDTIME (around 22.00)
Enter dose against time required. REGULAR MEDICATIONS MONTH APWL YEAR 2008
Use only one route for each entry.
279 284 299 309
Date -^- 27.9 MEDICINE ( Approved Name) SPECIAL INSTRUCTIONS PRESCRIBER ' S Pharmacist
Route * Atorvas' atin SIGNATURE
/3 Kftan
.
S r-JEurHor'i
Specify time Dose sign Supply
required 9Qmg
mane
Dose bleep no:JS&f7
change if
Morning 08.00 90mg 9*1

/ I3N HN
Midday
Evening
Bedtime
Enter dose against time required. REGULAR MEDICATIONS MONTH APRIL YEAR 2008
Use only one route for each entry
229
Date -^ 289 MEDICINE ( Approved Name) SPECIAL INSTRUCTIONS PRESCRIBER'S Pharmacist
A\u!h 3 Vitamin SIGNATURE
Route P
° S.M£ui Cn^
5 Taf- ron
Specify time Dose sign Supply
required JOOmg
t mana v Dose
change
Bleep no: 9389
Morning 0800 fOOrry

Midday
Evening
Bedtime
NON- ADMINISTRATION CODE: X Doctor 's request 2. Patient not on ward 3. Unable / No access
4. Refused 5. Medication not available 6. See notes
Unit 7
2 d 4 d Date of message
Mv ZUu Time of message
Remove c<w\uj* ^-Pfev l^sV Name of caller
Acse IV /\ E> s
Nature of call
on OY <*\ /WHbioHcs
Instructions
Kov\ifov Vewvp c ?we-PiO) y
*
Message documented in Yes / Not necessary
Patient Record
Signature of call recipient
V

6 a
FLUID BALANCE CHART
Name: Miss Judith Stavel
( Not to be filed in Medical Record )
U/N 473652338
Date: 14.11.2009
Bodyweiqht 72ka
24hrs from 0100 on 1? 1l 09 to 0100 on 15110?
INPUT
-
[OUTPUT
Time Oral Amount IV Fluids Amount PBP Asp Drains
01.00 / L N15 1O KVO (92 ml h r ) OF (900 )
02.00 92
03.00 42 / 00
04.00 1L 51, Dextrose 8 / 29 125 Wet bed'
05.00 Hz0 approx 100 125 Lge amt
06.00 IV ABs ' 100 ml 225
'
250
07.00 tea 20 12 5
08.00 125 Wei bed"
09.00 0J 150 125 BNO
10.00 tea 100 125 / 00 ml
11.00 125 300
12.00 1 L N / S 8 / 29 125 (JOrr ! B0 mod ami
13.00 125 01 m! UTT

14.00 125
15.00 125
16.00 125 BO srtil amt
17.00 H20 i cup 125 5ml amt
18.00 tea 100 IV ABs ' 100 ml 225

19.00 125
20.00 1 L 5% Dextrose <5 /24 125
21.00 milk 100 125
22.00 Ht0 50 125
23.00 125
24.00 125 55 ml
TOTAL
Unit 8
4 f
APPENDICECTOMY : WHAT TO EXPECT AFTER YOUR OPERATION
What is appendicitis ? in case there is a small amount of discharge analgesia running through the drip in your arm.
Appendicitis is the inflammation or swelling after the operation.If the discharge becomes When you are feeling uncomfortable, you can
of the appendix, a small tube on the end of the discoloured and smelly, you will have to take a press a small hand- held control button and you
intestine. course of antibiotics to clear the infection. will receive some pain relief through the drip in
your arm.
What is an appendicectomy?
An appendicectomy is the name of the
Will I have a drip'?
Yes. When you come back to the ward after your
,
s there anything else I ' ll have to do after
operation to remove the appendix . operation you will have an IV infusion, or 'drip', the operation?
in your arm,just until you are able to drink fluids We advise you to continue wearing your ant i-
Will I have a scar ? again. embolic stockings until you are up and about
No, you won f. The operation is performed by again. Keep up the deep breathing exercises too
passing a laparoscope through your navel and Will I be able to eat and drink after the using your tri -ball.
removing the appendix. A laparoscope is a tube- operation ?
like instrument with a type of camera on the end Yes,you will be able to eat a soft diet as soon as How soon can I get back to my norma I
of it.The surgeon is able to see your appendix the Nursing staff is satisfied that your bowels are activities.
through the laparoscope and remove it through working again after the operation, It usually takes a few days to recover from the
the same tube. operation and get back to normal activities.
Will I be in a lot of pain? However, make sure you avoid strenuous
Will I have a dressing? Any abdominal surgery can cause some activity for three to four weeks after the
You will have a small dressing over your navel discomfort. You will have patient -controlled operation.

4 f Patient questions:
What is appendicitis? Will I have a drip? Is there anything else I'll have to
What is an appendicectomy? Can I eat and drink after the do after the operation ?
Will the operation leave a scar ? operation ? How soon can I get back to my
Will i be in a lot of pain? normal activities?
Will I have a dressing?
6 a
THE ALEXANDRA HOSPITAL & U/N: 674903
Surname: Mainwaring
Given names: Belinda Anne
DOB: 3.8.1963 Sex: F
PATIENT PRE-OPERATIVE CHECKLIST Operation or procedure: Rt shoulder
arthroscopy and repair of rotator cuff
To be used as an added check so that the patient is fully prepared for his/ her visit to the Operating Theatre.
1 To be signed by Nursing staff on completion of patient preparation for Operating Theatre.
2 To be counter-checked by the nurse receiving the patient in the Operating Theatre.
NB: When check is completed, tick the appropriate column. YES NO or O/T
N/ A
1 Identification bracelet( s) correct and correctly worn x 2 /
2 Consent form signed
3 Operation site marked by surgeon
4 Charts correct, including Drug Chart, Prescription Chart, Notes, Fluid Charts
5 X -rays included with Charts and Patient Notes
6 Any known allergies
(Red bracelet worn Yes/No)
7 Caps, crowns, bridges
Identify position
8 Dentures removed (if not removed on ward, please state)
9 Operation site shaved
10 Nail varnish removed
11 Jewellery removed or taped
12 Identify piercings
13 Theatre gown worn / anti-embolic stockings / knickers
14 Pre -med given as per anaesthetic chart
Urine last voided at am/pm
Catheterised at am/ pm or N/ A
Fluid last given at am/pm
Food last given at am/pm
Prepared by ( Nursing staff - Ward) VJ Allum ( RN )
Date: 305.0S Time / / 00($n$J'pn\
Received by ( Nursing staff - Theatre) W McNoughtm CRN )
Date:305 OS Time / / / j g/pm
^

Unit 9
1 e Name: Mr Richard Symons
U/ N: 354609
Operation: removal of 2 cm2 piece of metal from abdomen post industrial accident
Post- op complications: very drowsy, slow to come out of anaesthetic. GCS of 12 /15 at
ll.OOhrs, 13/15 at 11.30hrs
.
Obs in Recovery: 11.30hrs Temp 36°, Pulse 70, BP 110/65, SaO. 97% on oxygen @ 3 L /min
IV Therapy: 1L Normal Saline over 8 hours
Nausea and Vomiting: nil, anti-emetic prn
Drains: one redivac in situ
Dressing: wound closure with clips, NAD intact
Pain: Pethidine lOOmg 3 hourly for 3 days, then oral analgesia
6 a
Pain Scales: Universal Pain Assessment Tool
This pain assessment tool is intended to help patient care providers assess pain according
to individual patient needs. Explain and use 0-10 scale for patient self -assessment. Use
the faces or behavioural observations to interpret expressed pain when patient cannot
communicate his/her pain intensity.
NUMERICAL o 2 3 4 5 6 7 8 9 1 0
DESCRIPTOR
SCALE
VERBAL NO MILD
rn MODERATE
i [
MODERATE SEVERE WORST PAIN
DESCRIPTOR PAIN PAIN PAIN POSSIBLE
SCALE
WONG-BAKER
oo O G
FACIAL GRIMACE
SCALE
Alert No humour Furrowed brow Wrinkled nose Slow blink Eyes closed
Smiling Serious Pursed lips Raised upper lips Open mouth Moaning
Flat Breath holding Rapid breathing Crying
ACTIVITY NO CAN BE INTERFERES INTERFERES INTERFERES BED REST

TOLERANCE PAIN IGNORED WITH TASKS WITH WITH BASIC REQUIRED
SCALE CONCENTRATION NEEDS
Unit 10
2 6 Mr Edward Vogel had a left CVA and has moderate right- sided weakness. He lives on his own in a
bungalow which will have to be adapted for his current needs: a bathroom adaptation and ramps
in place of steps. A home assessment has been arranged for 1 5 October. His next of kin is an
old friend, Eva Sanki. He will need his meals delivered as he cannot manage to cook for himself .
4 d Mr Lachlan suffered a left CVA eight weeks ago, causing a right hemiplegia.
Explain to Mr Lachlan’s daughter, Ruth, the effects of a left- sided stroke.

4 e Discharge Plan and checklist - to be commenced on day of admission
Circle multiple choice answer
Patient name: Date of admission: Name of carer/relative: Dosette Box used
U/N: Yes/No
Address: ( addressograph label)
EDD:
Home care: community services

Does patient have Which services ? Have they been cancelled ?
existing services ? Yes/No or N/ A
Yes /No Frequency ? Date:
District Nurse Reason ? District Nurse cancelled ?
Yes/No Yes/No or N/ A
Frequency ? Date:
Aids/ Adaptions to be put in place for Which aids ? Include oxygen + Date planned for aids to be in place:
discharge ? nebuliser
Yes /No or N/ A
Home circumstances
Accommodation: Lives alone / carer Digital door code: Name of care home: House key kept with:
bungalow / flat / (relationship and Yes/No
house / care home name) Number: or N/ A or N/ A
Multi disciplinary team referrals
-
Date referred Date seen Seen by whom Outcome

Physiotherapist
Occupational Therapist
Medical Social Worker
Clinical Nurse Specialist
Other
Prior to discharge
Plans discussed and agreed Plans discussed and agreed with District Nurse informed Outpatient
with Ptycarer MDT Yes/No appointment booked
Yes/No Yes/No Date: Yes/No or own GP
Equipment/ Aids delivered to Dosette Box required for discharge Essential food, water, heating Transport arranged
patient 's home Yes/No in situ in own home Yes /No
Yes /No Pharmacy aware Yes/No or N/ A
Yes/No
Date Signature of person completing

Print name Grade

Unit 1
Patient details 5 h THE ALEXANDRA HOSHTAl
U/N: 213498
Surname: Lancaster
Full name Edna May Harris Given names: Pollv
DOB 13 July 1943 PATIENT RECORD DOB:14.06.1942
Reason for admission possible amputation Rt. middle

DATE & TIME Add signature,printed name,staff category,
toe date and time to all entries
Past medical history WAKE ALL NOTES CONCISE AND RELEVANT
PVD (peripheral vascular disease) Leave no gaps between entries
Past surgical history Rt. femoral angioplasty
Medication
20.5.200« Airs Lancaster had a restless night c / o
paracetamol x 2 four times a day, 05.30/irs. chest pam at 0ZI 5hrs. Night 5HO called.
ferrous sulphate x 1 daily
Allergies
.
BP 2 / 5/ 105 P ?z at QZZOhrs. CCG ordered
N /K ( nil known) and attended by nursing staff 0 .. via mask
Next of kin Rose Hlavarty and GTN si administered . BP dropped to
1 &0 / && P &2 at 0 ZlK)hrs. No c / o further
chest pain.
Unit 2 L Knight CRN )
Student B
You are working with a colleague on the evening shift. You have both read Mrs Oondahi's
notes. Ask and answer questions about Mrs Oondahi's respiratory status using the prompts.
comfortable? trouble / breathing ?
oxygen ? last / pain score?
Unit 4
3 g Ms Sylvia Smythe is a 27 -year-old who was diagnosed with Type 1 diabetes after
a sudden onset of increased thirst and frequent urination She had also lost a .
lot of weight despite having an increased appetite. She has a family history of
hypertension and has recently noticed that her blood pressure is quite high.
Ms Smythe has been admitted to hospital after experiencing some serious
hypoglycaemic attacks. One occurred while she was on the bus going to work .
She was very lucky that a young nurse was sitting next to her and recognised the
acetone smell of her breath as a symptom of diabetic ketoacidosis During this .
hospital admission her insulin use, diet and exercise program will be reviewed.
Unit 7
2 d
.- . .
4 d
Mvs Langley Telephone tOard fbC Mr - s
booxed 4-o have a PICO i £ nser 4-ed
- flush C<7IMVVU) <7\ wifh hep <nm iv\ st- e <n<A o-P H / <> behave
4-CH ,orrceo 10.30 Cow. fe r.fesds a
-
giving JV A& s
- Give 10° liWes iv\ sfe <*uA S’0 UWes
.
p0r 4"£r 4*o hrirrtj h **, 4 o 4*h XV
"
XnfuSiCn Rco*w Don’ 4- Ccr &4- XV

- W^VcU Ic levels Pr 6SCCi£>4-»On Char -h uj 4 h h»^ .
“
^
Unit 10
4 d Mrs Polansky suffered a right CVA eight weeks ago, causing a left hemiplegia .
Explain to Mrs Polansky’s daughter, Ewa, the effects of a right-sided stroke.

AUDIOSCRIPT
Mrs Chad: I don ’t know, but I've got them here really pleased that you 're fired up and ready to
Shona: Good morning. Mrs Chad. My name’s with me. I was told to bring them. go. The only other thing that we need to talk
Shona . I’ll be admitting you to the ward Shona: Mm. That’s good , [smiles] Do you think about is your blood pressure itself. It would
today. Would you like to come into the Patient you can show them to me, please ? be a good idea to buy a small blood pressure
Admission Office so I can get some paperwork Mrs Chad: Yes, I can. I 've got them somewhere monitor and take your blood pressure regularly.
done ? in my bag. Here they are. I take them in the That way you can keep an eye on it yourself. It
morning with breakfast. puts you in charge of your own health. I think
Mrs Chad: Good morning, Shona . Yes, thanks, I
that’s important, don't you?
could do with a sit down. Shona: Right, that’s fine. You’re taking
metaprolol to lower your blood pressure. I’ll just Mr Hockings: Yeah, you' re right. It's much
Shona: Here you are. You take this chair here.
write down the name of the medication on the better that way.
You can put your stick on the edge of the chair
if you like. admission form. Metaprolol. Do you have any
allergies to any medications ? 1.4
Mrs Chad: Oh. Thank you, dear. Emily: Right , now Mrs Cho in bed number five.
Shona: How are you today ? Mrs Chad: Not that I know of.
Mrs Cho was readmitted yesterday because
Mrs Chad : Not too bad, thank you. I haven’t Shona: Urn. What about food allergies? Any of uncontrolled hypertension. You’ll probably
been waiting for too long at all. food which doesn't agree with you? remember her from last week. She went home
.
Shona: That's good. Now I'm going to be Mrs Chad: No, no, nothing like that .
Shona : Good. [smiles ] Are you allergic to
but couldn 't manage her ADLs by herself. Her
taking down some details before you’re daughter had to come in every morning to give
admitted to the Cardiac Unit today. I'd like to sticking plaster or iodine? her a shower and help her during the day. She’s
ask you a few questions, if it’s all right with Mrs Chad: No, I've never had any problems been quite distressed about it, according to
you? before. her daughter. She presented to the unit with
.
Mrs Chad: Yes of course. That's fine. Shona: All right. Can you tell me the name of uncontrolled hypertension, despite a change in
medication. She has a past history of Ml this
Shona: All right, well now, let me just get the your next of kin?
year in June. Urn, this morning she complained
admission form. Mrs Chad: It's my son, Jeremy. Jeremy Chad.
of chest pain. The SHO was called. Her BP
1.2
Shona: Thanks. That 's all for me. I'll leave you
here for a minute while I get the admitting
.
at the time - er that was 10 am - was two
ten over one oh five and her pulse was one
Shona: Right, let's get started. Would you mind doctor to come and see you. Are you hundred. She had an ECG done and was given
if I check out some details first? comfortable? GTN sublingually. We gave her some via
Mrs Chad: No. not at all. What would you like Mrs Chad: Yes, thanks. I'm quite all right here. the mask and she seemed to settle. She's in
to know ? for cardiac catheterisation tomorrow to assess
Shona: [ smiles ] I’d just like to check your 1.3 the extent of the damage to her heart. I've
name and date of birth and see if your identity Susanna: Hello , Mr Hockings. I wondered if I booked the porter already. Strict fourth hourly
bracelet is correct. Can you tell me your full could have a chat with you about your blood obs. BP and pulse and report any chest pain
name, please? pressure management before you go home? immediately, of course. She's had no chest pain
.
Mrs Chad: Yes it’s Doreen Mary Chad and Mr Hockings: Hello, Susanna. Yes, sure. this shift.
my date of birth is the fifth of June nineteen Susanna: Great. I'll just grab a chair, [gets a
twenty - three. Quite a while ago, isn't it ? .
chair and sits down ] Now you 've had a bit of a 1.5
Shona: [ smiles and laughs ] Not so long ago. shock with your blood pressure, haven' t you? Nick: Mrs Smits complained of chest pain at
Time goes very fast when you’re busy, doesn’t Mr Hockings: Yeah, you're right there. I had no 10 pm. The SHO was informed. Oxygen was
it? Right now, let’s see. Doreen Mary Chad. idea. I mean I was feeling a bit more tired than administered via a mask . Her blood pressure
C- H- A-D. That's correct, isn’t it ? usual, and my wife said she noticed that my was two hundred and twenty over one hundred
Mrs Chad: Yes, that’s right. Chad with a ‘d’. face was a bit flushed. The thing is that I never and her pulse was one hundred and twenty at
Shona : And your date of birth is the fifth of thought about blood pressure. five past ten. The SHO ordered an ECC, which
June nineteen twenty - three. .
Susanna: Mm yeah [ nods ] . That's probably was done by nursing staff. GTN sublingual was
given with good effect. The chest pain was
Mrs Chad: Yes . why they call it the ‘ silent killer '. For most
relieved within a couple of minutes.
Shona: All right. Can you tell me why you're people, the only symptom they have of
here today? hypertension is high blood pressure itself.
1.6
Mrs Chad: Well, urn, I’ve got high blood Mr Hockings: Like you say, it’s come as a bit
Jenny: All right, now I 'll just let you know
pressure, and I'm here for some tests. My of a shock. So, what do I have to do when I go
home ? What should I watch for ? about Mrs Small’s BP. As you know, she was
doctor asked me to come here to see what’s admitted just before 2 am yesterday with
going on . Susanna: Well now, remember yesterday we poorly managed hypertension. She 's quitp
Shona: OK. Now I' d like to ask you about your went through the sort of lifestyle changes I’d elderly and trying to cope at home, but the
past medical history. Have you had any serious like you to look at? previous medication wasn't working well for
illnesses in the past? Mr Hockings: Yes, I’ve got all the information her at all . Doctor Fielding wants to put her on
Mrs Chad: Yes. I had a mild heart attack last about the Stop Smoking service, and I’ve something else and wants to monitor her BP in
year. It was quite frightening. started on the nicotine patches. The dietitian hospital over three days. If you look at her Obs.
spoke to me yesterday about a healthier diet . Chart from yesterday, you'll see that she was
Shona : [ leans towards patient and nods ]
My wife even went out and bought a cookbook ! quite hypertensive on admission. E3 P was one
. .
Yes I'm sure it was. Now er, what about
We ’ ll both start the exercise programme here at hundred and seventy three over one hundred
past surgical history? Have you ever had any
the hospital. Was there anything else? and one, pulse eighty -six . At 6 am her BP was
operations?
Susanna: [ laughs ] I hope the recipe book was about the same, one seventy - five over ninety
.
Mrs Chad: No I’m very lucky. I never have.
for you. I can see you cooking up a storm in the and pulse seventy - six . During the morning shift
Shona: [ smiles ] That is lucky. Now, are you kitchen . at 10 am she shot up to two hundred and ten
taking any medications at the moment? over one thirty, with a pulse of a hundred and
Mr Hockings: I don’t know about that. I don't
.
Mrs Chad: Yes my doctor put me on some think my wife would agree with you. twelve. She had some chest pain , too. Doctor
blood pressure tablets after my heart attack. Fielding came up to see her about the chest
Susanna: You did well to remember all the
Shona : [nods] Do you know what they’re pain and high BP. He did all the usual things for
information. It 's a lot to take in at once and I'm
called? her ECG, GTN sublingually, and she settled a
bit by 2 pm. By two, her BP was one ninety- five
94 Audioscript
- ninety and her pulse was ninety-seven.
_:ok her obs. again at 3 pm, just before
•
Mrs Drake: Oh , so I have to do three readings
every time?
your respiratory system . That's the one. Now .
I’m going to tell you what happens to the air
- andover. She 's gone down to one eighty over .
Eleanor: Yes that's right. Take three readings when it comes into our bodies and travels to
r > ghty - five with a pulse of eighty - six . Doctor but only record the highest on your chart. Do our lungs.
Fielding's happy with that but just keep an eye you have any questions ? Susie: Is that, like, when you 're having an
cn her, will you? Mrs Drake: No, I think I've got all that. asthma attack ?
2.1 Tim: Good point No, I'm talking about what
2.3 happens normally, how the air should move
Eleanor: Good morning. Mrs Drake. How are
Melanie: Hello, Mr Dwyer. I'd just like to show into our lungs.
you?
you how to use this nebuliser. I'll bring a chair Susie: Oh. OK .
Mrs Drake: Much better, thank you. My chest up so I can have a chat with you. You haven't
feels less tight and I ' m breathing much better Tim: Right, let's start. The air is breathed into
used one of these before, have you ?
now. your nasal cavity - that’s your nose - where
Mr Dwyer: No, this is all new to me. I've been
Eleanor: [sm//esj That’s great. I'm going to it s warmed and filtered. It moves past the oral
using an inhaler for years now, but this time it
show you how to use a peak flow meter today. cavity, that’s your mouth. Now it goes through
just wasn 't enough.
Would you mind if I go through it with you your pharynx , or throat, and then comes to
Melanie: Well, let’s hope you only need the the epiglottis. That’s the little flap which stops
now? You 'll have to use one regularly to keep
nebuliser for acute attacks. The inhaler should food going into your lungs when you swallow.
an eye on your asthma at home.
be enough as a regular preventer. The tube which carries food to your stomach is
Mrs Drake: No, that'll be fine. I’m happy to
Mr Dwyer: OK . So what do I have to do? right next to it , so that part is like a road which
do anything which will stop me going back into
hospital. Melanie: Right. Well , I'll go through all divides into two roads. Can you see that?
the steps with you. It 's not too difficult. I'm Susie: Yeah Hey. this is interesting
.
Eleanor: Yes it's much better to manage it at sure you’ll catch on quickly. First of all, fill '
Tim: Oh, great! I thought you’d find it
.
home. Now I’d like you to use this peak flow the chamber of the nebuliser with inhalant interesting. Now. the air is moving past your
meter at the same time every day.
Mrs Drake: Oh , all right . Is that important ?
medication. The inhalant solution is in these
small plastic nebules.
.
larynx , or voice box so that you can make
sounds. It moves down your trachea, or
I mean , is it important to use it at the same Mr Dwyer: OK , I just put the solution in the windpipe, and into the bronchus. That's the
time every day ? chamber here. That’s right, isn’t it ? part which swells when you have an attack .
Eleanor: Yes, it's so that you can compare the Melanie: Yes, that’s the right place. Now, We’ll talk about what happens in an asthma
readings. It's better if they 're taken at the same attack later, OK ?
attach the tubing to the oxygen outlet on
time each day.
Mrs Drake: Oh, I see.
the wall. It’s this outlet here, not the other .
Susie: Yeah OK. What happens to the air now,
one. That's for something else. That’s quite Tim?
Eleanor: Another thing - could you record
your readings in this Daily Record Chart ,
important. Urn . are you OK with that ? .
Tim: Oh I can see you’re right into this! Well,
Mr Dwyer: Right. Yes, I' ve got that . see how the bronchus divides into the two
please? I’ve got one for you here. Melanie: Next, put on the mask and tighten lungs? That's it. The lungs are covered by the
Mrs Drake: Right. So I take the peak flow the elastic straps so that it fits snugly around pleural membrane. That’s the special covering
reading at the same time every day and record the head. I'll show you . that protects your lungs. Pleural is just a
it in this Daily Record Chart ?
Eleanor : |nods] Yes. That's right You just write
Mr Dwyer: Yes, I see. Got it . medical word for lungs. Inside the lungs are
the alveoli , which are masses of tiny sacs which
Melanie: After that, turn on the oxygen ... so
OIL* derails along the line for that day. like this. the liquid medication turns into a fine mist. I’ll
help your lungs to exchange carbon dioxide for
Something else which is important is, I'd like oxygen. Then you can breathe out the carbon
just turn it on. You should put it at around six
you to bring the Daily Record Chart with you dioxide.
litres.
every time you come here to the Asthma Clinic. Susie: I get it now. What about these things
Mr Dwyer: I see. It’s starting to fizz up.
Mrs Drake: AH right, J’ll do that So, just 50 I around the lungs?
Melanie: Mm. Yes, that’s the idea. Finally,
know I have it correct: I take the reading every Tim: Those are your ribs. In between the ribs
inhale the mist until it 's finished.
day at the same time, then I write the result on we have the intercostal space. Intercostal is
my Daily Record Chart, and I mustn’t forget to Mr Dwyer: OK . And then I just turn it off ? the medical word for ’in between the ribs.' Well
always bring the chart to the Asthma Clinic. I' ll Melanie: Yep , until the next time. Any done, Susie. You' ve got all the labels there.
never remember all that! questions ?
Eleanor: [sm/Ves ] Don’t worry, it'll become a .
Mr Dwyer: No I think you've covered 2.5
habit. everything. Thanks. I think I’ll be fine with it. Tim: Have a look at the next page for me. Can
Melanie: Yes, I' m sure you will. I’ ll check on you you see the two diagrams?
2.2 when you're ready for the next dose . Susie: These ones ? One says it’s a picture of
Eleanor: If you're ready, I’ll just show you how healthy airways and the other is a picture of a
to use the peak flow meter. It’s easy to use. You 2.4 person who's having an asthma attack .
just need to follow some simple instructions. I’ll Tim: Hello, Susie. Can I come and sit here with Tim: That's right. Let’s call this one healthy
go through it with you. you for a while ? You 're looking a bit brighter airways and the other one asthmatic airways.
Mrs Drake: All right , thanks. than yesterday, aren't you? We'll have a chat You can see that the healthy airways have a
Eleanor: Right, first of all, just move the red .
about your breathing now and then I'll have a lining of healthy tissue. The tissue layer isn’t
indicator to the bottom of the numbered scale, talk to you about what happens to your airways very thick.
like this. when you have an asthma attack. OK with you? Susie: But the tissue in the asthma airways is
Mrs Drake: Yes, I can see where the indicator Susie: Why do I have to do all that ? Sounds thicker, isn' t it?
goes. like school! Tim: Yes. the tissue in the asthma airways
Eleanor: Now, stand up . Take a deep breath Tim: Come on. It's not as bad as that! The becomes inflamed.
and try to fill your lungs as much as you can. thing is, Susie, I want you to be able to Susie: What's the layer around the tissue
Like this. Place your lips tightly around the understand what’s happening to you during an called?
mouthpiece. Could you show me ? Yes that’s . asthma attack , so that you can cope when you
have another attack . Does that sound like a
Tim: That's a muscle layer. The muscle
right. Next, blow as hard and as fast as you can layer contracts, or squeezes. In the healthy
with one breath , Have a go! That's great . Make good idea ?
airways, the air flows through the airways
a note of the final position of the marker. That 's .
Susie: Yeah I suppose so. So what do I have and is conducted into and out of the alveoli,
your peak flow reading. After that, I want you to do? or tiny air sacs. In the alveoli, carbon dioxide
to blow into the peak flow meter two more Tim: Well, I' ve got this little booklet for you to is exchanged with oxygen. This is called
times. The last thing to remember is to record take home with you. Have a look on the first respiration , or breathing.
the highest of the three readings on your Daily page, and you 'll see a diagram of what we call
Record Chart .
Audioscript 95
Susie: What happens to the other airway - I Rosa: That 's OK , I don' t mind. Mrs Castle's on We’re unsure of the best wound management
mean, to the asthmatic airway ? hourly resps, isn’t she ? for him. What would you recommend that we
Tim: You remember that the tissue in the Mandy: Yeah , that’s right. She’s had a history change to ?
asthma airways becomes swollen during an of respiratory problems, and she became quite Sophie: Hm, let me have a look at the wound
asthma attack ? breathless after her operation yesterday. In any and we’ll see what the best option is.
Susie: Yeah. case, we're still doing hourly resps while she’s
Tim: Well , the muscle squeezes the swollen on PCA fentanyl for pain . 3.2
tissue and the lining of the airways swells as Rosa: Uh -huh OK , right . How 's her respiratory Sophie: Hello, Mr Jones. My name's Sophie.
well. This means the airway is narrowed. Can rate now? I’m the wound management Clinical Nurse
you see that there is less room for air to go Mandy: Urn , you can see her pre -op resps at Specialist here.
through ? 6 am were eighteen. That's about normal for Mr Jones: Oh. Hello , Sophie.
.
Susie: Yeah I can see that . her. I checked her resps at 7 am before she Sophie: I believe you’ve been having a rough
Tim: That’s why your chest muscles tighten went to Theatres and they were still eighteen. time with your leg wound? Would you mind if I
and it becomes difficult to breathe. You start Rosa : Mm. When did she come back from the have a quick look at it ?
wheezing when you breathe in . It also takes operation? .
Mr Jones: No, no, no I don 't mind .
much longer for you to breathe out again. Mandy: She came back a couple of hours ago, .
Sophie: Now, while I take this dressing off tell
Susie: I hate that! . .
at um 2 pm . She was in a lot of pain. She me how you've been managing at home.
Tim: It's frightening when it happens, isn’t it? scored seven out of ten on the pain score, and Mr Jones: Oh, well , you know, it’s a bit hard
Now that you know what happens during an she was quite breathless. Her resps went up to on the wife. She doesn’t cope with things very
asthma attack, it’ll make it easier for you to twenty-six . I started her on some oxygen at five well. I' ve been doing most of the things around
understand why you need your medication. litres per minute for an hour between 2 and 3 the house for the past few years, but I can’t
pm because of her breathlessness. do much now. I've had a difficult time with this
Susie: Yeah, thanks, Tim. I'll look at the book
until mum comes back. Rosa: Mm . OK . Yes, I see. It looks like she’s wound. I've tried my best, but I just can 't do it
settled down a bit since then. The fentanyl will on my own . What do you think I should do with
2.6 have kicked in. I can see her pain score at 3 pm this ulcer ?
i was four out of ten. That's better. .
Sophie: Well I think the first thing to do is to
Mandy: Yeah. I just did her obs. a few minutes reassess the wound. Sometimes you have to
Now to Mr Frank. Mr Frank is really at a
ago at 3 pm and her resps were down to come into hospital to get back on track with
terminal stage now. His pain was not relieved
by morphine 5 mg via continuous infusion. The twenty so that's better too. I've put the oxygen treatment . OK , Ali, I think that we need to
morphine was increased to lOmg. and this back to three litres per minute. use a different type of dressing method on the
seems to be holding the pain now. Mr Frank 's Rosa: OK. I’ll keep an eye on her while you're wound.
respiratory rate is depressed since the increase on your tea break . Ali: Right. What do you suggest we use ?
in the morphine rate via the subcutaneous Mandy: Thanks. I'll be back in half an hour. I’ll Sophie: Er, I'd like to use a VAC dressing on
pump, but this is to be expected. Just keep him do her 4 pm obs. then. this wound.
comfortable tonight, please. His family will stay Rosa: OK . Mr Jones: Oh. Sounds nasty.
with him all night in the single room. Sophie: Mr Jones, it’s called a VAC. which
2 3.1 means Vacuum Assisted Closure, but it 's only a
This is Judy Brown in bed 1 7. I'll just get Sophie: Hi. gentle suction on the wound.
her charts so I can show you what 's been
happening today. OK . Here they are. She
.
Ali: Hi Sophie. Thanks for coming up to the
ward. It’s about Mr Jones in bed five. Would
Mr Jones: I see. Do you think it’s a good idea
to try that instead of the dressing that they’re
came back to the ward at 11 with a PCA you mind giving me some advice on his wound using now ?
with morphine running post -op. I’ll check care management? Sophie: Yes. I think it'll help the wound heal
the settings with you in a moment, but I just Sophie: Yeah, sure. Can you fill me in on his faster.
wanted to be sure you know to monitor Judy 's past history first ? Mr Jones: All right. Sounds like a good idea.
respirations second hourly as per the Clinical
Pathway. OK. so let’s go through these settings.
.
All: Um right . Mr Jones is a 68- year -old Sophie: Would you mind if I covered your
smoker with a long history of PVD. He wound with a dressing towel for now, while I set
3 developed a venous ulcer on his right ankle up the new dressing?
Hello , it ’s Barbara from Ward 15 here. Are you after he tripped on some stairs at the back of
Mr Jones: No, no, I don't mind. You take your
the physio on call this weekend? Oh good.. . .
his house. That was er about six months ago.
time.
Look, I thought I’d let you know before you His local doctor had a look at it and asked the
came up ro the ward. Mr Walker was very District Nurses to come and dress the wound
breathless this morning, but it was helped by at home. Um. they’ve been dressing the wound 3.3
oxygen at four litres per minute via the nasal three times a week . At that stage it was hoped John Simpkins: Good morning, everyone.
cannulae. He may not feel able to have any that he could avoid coming into hospital. He Morning. Thanks for coming to the session on
physio today. Do you still want to come up and lives with his wife who needs quite a lot of help wound bed preparation this morning. I think
. .
see him? Mm OK that 's a good idea. I’ll tell as she has chronic asthma. It puts quite a lot of you’ve all got the handouts, yes? Good, OK.
him you’ll be up tomorrow morning instead. strain on her if he has to be hospitalised. First of all, I'd like to talk about the aim of
Thanks. Bye. Sophie: Right , that’s difficult, isn't it? wound bed preparation and then the barriers
4 Obviously the ulcer didn’t improve at home, so .
to wound healing. Now I'm sure all of you have
had experience with caro of different LVP^S
I'll just explain to you what’s happening with what happened next? of wounds. As you probably know, wound
your husband's breathing. Mr Sims has a Ali: Um. Two weeks ago he was admitted bed preparation is an important part Of the
fast respiratory rate at the moment, which to this ward to have an assessment of way wounds are managed these days. The
is caused by trie lung infection he's had for his circulation and to monitor his wound preparation of the wound bed - in other words,
the past few weeks. He has very laboured management. He had a Doppler test done, the base of the wound - is vital if healing is
inspiration and expiration, which is why I've er, last week which indicated poor blood to take place. I know you 'll agree with me that
given him some oxygen. circulation in his lower legs. Um. he's also been wounds which are resistant to treatment are
spiking temperatures and the surrounding skin very frustrating, not least to the patient. The
2.7 of the wound has become quite reddened. We aim of wound bed preparation is to prepare
.
Mandy: Hi Rosa. Do you mind if I go through .
sent a wound swab off and we just got the a stable wound environment which results in
Mrs Castle's chart with you before I go on a results yesterday. Of course, he's growing a few wound healing. This is achieved by restoring a
break ? There are a few things to do while I'm bugs so he’s started on some IV antibiotics. well-vascularised wound bed, or wound base ,
gone, if you don’t mind.
96 Audioscript
' hat good blood circulation is achieved and
•
_
e tissues are supplied with oxygen and other 3.5 Jennifer: Right. Um, he had a wound review
- orients. It’s also important to decrease the .
Krisztina: Hello Gary, isn 't it? I'm Krisztina yesterday, as the wound had to be reassessed.
high bacterial load by controlling inflammation and Lhis is Judy. The edges weren’t healing because of the
or infection. In addition, it’s necessary to create Judy: Hi. infection. The wound is quite sloughy, too. but
moisture balance in the wound environment , Krisztina: How are you doing? it isn’ t necrotic The surrounding skin is a little
so that the wound is neither too dry nor too inflamed so he was started on IV antibiotics
Gary: Not too bad now, I' ve had something for
moist. Studies show that wounds will not heal yesterday. It was decided to debridc the wound
the pain, so it 's bearable now.
if there are certain barriers to healing present in line with wound bed preparation guidelines.
.
Er the first barrier to healing is the presence
. Krisztina : That's good . You've had a tetanus You all went to the CPD session on that last
shot, too, I see. We'll clean up the wound for week, didn’t you?
of necrotic tissue - in other words, dead you now. I'll leave you with Judy and she’ll do
tissue The necrotic tissue stops healthy tissue Felicity : Yeah, everyone went and I've put the
the dressing for you.
from growing, so it 's important to guidelines up in the Treatment Room .
remove any Gary : OK . thanks. It looks pretty awful
dead tissue from the wound. After necrosis, , doesn't Jennifer: Oh, that ’s good. He went , uh. this
it ?
high bacterial load, or a high level of
.
the second barrier to good healing is um ,
.
Judy: Mm it was a nasty bite, especially with
morning for a surgical debridement of the
infection
which is carried by the tissues. It’s therefore those puncture wounds. Krisztina, what do you
wound and came back around 2 pm He's .
feeling OK after the debridement ; it ’s not too
important that any infections are treated suggest I clean the wound with?
sore. Ah, there's a small amount of purulent
before effective wound care can start. Finally, Krisztina: It 's best to flush it with lots of ooze. There's just a little pus in the centre of
imbalance of moisture levels in the wound bed Normal Saline before you do the dressing. We the wound. The wound has an antimicrobial
also stops the healing process. Wounds with do that first. Gary, because it reduces the risk dressing over it. which is to remain intact until
.
excessive exudate - that is wounds which of infection. Even though only fifteen to twenty
per cent of dog bites get infected, puncture
tomorrow. After that it ' ll need
, J daily dressing .
are too moist and also wounds which have please.
excessive dryness or desiccation - will not heal
properly.
wounds like yours have a greater chance of
infection. You 'll be prescribed some antibiotics
.
Brian: OK that's good. And he ' ll have an
assessment by the Vascular Team on Monday,
to lake at home, too. right ?
3.4 Gary: Um. Speaking of going home, can you Jennifer: Yes. that’s right.
.
John Simpkins: Right I 'd like to talk about give me some advice on looking after this at
TIME now. TIME is an acronym for a framework home? 4.1
which helps to identify barriers to healing
in the wound bed and identifies expected
Krisztina: Sure. The wound will be left open,
um , it won’t be sutured. Gary, because it heals
.
Susan: Good morning Mrs Kim . My name’s
Susan. I'll be working out your diabetes
outcomes of treatment. The acronym TIME better if it's left open nofstitched closed. I'd management plan with you today.
stands for tissue , infection moisture balance
, like you to keep the dressing clean and dry Mrs Kim ; Hello , Susan. Pleased to meet you ,
and edges of the wound. Looking at the and come to Outpatients to have the dressing
tissue factor first , the tissue is not viable if Susan: Come on through to the clinic . This is
changed daily. I'll get you an appointment card
there are still areas of necrosis in the wound. your first visit here, isn't it?
while Judy’s doing the dressing for you.
This means that the tissues of the wound Mrs Kim Yes. it's my first time at this clinic .
Gary: Mm, all right . What should I do about
bed do not have sufficient blood supply to I was in hospital last week and they referred
the antibiotics?
survive. Debridement of necrotic tissue is me here after I was discharged. I'd had a few
Krisztina: You’ll be prescribed some antibiotics
necessary to prepare the wound for healing.
This is oiten a surgical procedure, especially by the doctor a bit later. You 'll get a script
problems controlling my diabetes at home .
which you can take to the hospital pharmacy to Susan: Oh dear, that's a shame, but I'm sure
if large amounts of necrotic tissue have to we ll be able lo sort something out today The
be filled. Make sure you take the whole course
be removed. The expected outcome is a main purpose of your visit here today is to
of the antibiotics. That’s very important, Is
wound bed which is well- vascularised and has develop a Personal Care Plan for you. I' d like
there anything else you were concerned about?
a good blood supply. The second factor to to fill you in about the way we work here, as
consider is whether inflammation or infection Gary: Oh, just one thing. Um , should I get a you may not be familiar with the Primary Care
is present. The aim is to remove the infection medical certificate ? It looks like I might be off Team.
and reduce the bacterial load. This is done work for a couple of days . Mrs Kim: Oh. no. I' ve never heard of that. How
by using antimicrobial dressings as well as Krisztina: Yes. that’d be a good idea. I'll ask is it different from what I did before?
antibiotic medication. Reduced inflammation the doctor on duty to write one for you.
Susan: The main difference is that we are
around the wound is the expected outcome. building what we call a Practice Team between
Next , the moisture imbalance of the wound 3.6 us here at the Diabetic Clinic, your local doctor
is treated. Excessive exudate, or discharge of Jennifer: OK. moving on to Gary, um . Gary
and. most importantly, you ,
fluid from the wound, causes maceration, or Stephens in bed 17 Does everyone know
.
Gary ? He was attacked in the street by a dog Mrs Kim: Oh. yes. that is a bit different. My
softening , of the wound edges. On the other
hand, desiccation, or excessive dryness, also two weeks ago. Initially he went to A & E and
local doctor was the only person who looked
slows healing. In order to restore the moisture was treated there. He had some deep puncture after me before I started at the Diabetic Clinic
balance, it 's necessary to use hydrating wounds in his left calf and was in a lot of pain. Susan: Mm. My job is to ensure that there is a
dressings which add moisture to dry wounds. Brian: The dog bit him twice, didn’t it ? good communication network set up so that we
Negative pressure dressings, for example VAC can keep track of any changes in your diabetes
Jennifer: Yeah , and it bit him quite deeply. before they become a problem .
dressings, remove excess fluid in macerated
wounds. The expected outcome is that the
.
As I said, he went to A& E, um the wound
wasn't sutured but kept open as per the Mrs Kim: That would be good. If only I'd
wound will have an optimal moisture balance. protocol for dog bites with puncture wounds. known about this before, maybe I could 've
Finally, if the edge of the wound does not heal Gary was given a tetanus shot and sent home avoided the last hospital admission. I was
or advance, the wound becomes a chronic doing so well and then I just seemed to go
with instructions to come to the dressing
wound. It then becomes necessary to reassess clinic every day to have the dressing changed. downhill fast.
the wound. During reassessment, different Unfortunately, he tried to do it himself and now Susan: Mm. Yes, that would be frustrating.
wound management needs to be considered. he has an infection in the wound and has been What happened?
An example of this is a skin graft, which is used
to replace damaged skin. The desired result is
admitted to hospital for treatment. Actually, it's .
Mrs Kim: Well I got very run down, and I
quite a bad infection. The wound smells quite didn ' t watch my diet .
that the edge of the wound will advance and a bit. Susan: Well , these things can happen.
heal. Brian: So what are we doing with the wound
now ?
.
Mrs Kim: Yes well, I ended up in hospital
because I couldn' t control my blood sugar level
at home.
Audioscript 97
Susan: Mm. I see. Well, let 's have a look at
your routine at home. Can I ask you a few 4.3 Nadia: The second option is insulin with an
Nadia: Now the normal pancreas produces a insulin syringe. Insulin is drawn up from a vial
questions?
hormone called insulin in the beta cells. Insulin into a disposable syringe. This means that the
Mrs Kim: Sure.
regulates blood sugar levels by moving glucose .
dose required can be drawn up and varying
from the blood into muscle, fat and liver cells. doses can be drawn up if needed.
4.2
The glucose can then be used as fuel for the Beth: Would that be, say, if you ’ d eaten a little
Marta: Hello, Mr Williams. Good to see you
body. extra treat that day?
again.
Beth: Mm. Right. Now what happens when a Nadia: Could be. Also, one or two types of
Mr Williams: Hello, Marta.
person has diabetes? insulin can be mixed in the syringe as long as
Marta: I 'd like to talk to you today about you follow the rule: cloudy insulin before clear
Nadia: Well, the diabetic pancreas either
lifestyle and nutrition. You'll have to make some insulin.
produces no insulin at all in the beta cells,
major lifestyle changes if you're going to avoid
or too little insulin to normalise blood sugar Beth: Right. The markings on the side of the
nasty complications of diabetes.
levels. Type 1 diabetes is usually found in syringe look quite small, don't they?
Mr Williams: All right . I know I haven’t been children, so you may know it as juvenile Nadia: Mm, the markings are difficult to see,
looking after my health lately. I've put on a bit diabetes. It occurs when no insulin is produced. which makes drawing up accurate doses more
of weight . People with Type 1 diabetes have to have daily difficult. It's the cheapest option but the least
eat ?
.
Marta: Mm how many meals a day do you injections of insulin. convenient.
Beth: I see. Now what about Type 2 diabetes? Beth: Right.
Mr Williams: It depends. Sometimes I skip Nadia: It's much more common than Type 1 . Nadia: That leads us to option three. It’s
meals. I just can' t be bothered. Actually, it makes up around ninety per cent called an insulin pen. This one has an insulin
.
Marta: Yeah I know it must be difficult for of all cases. The pancreas produces too little cartridge which fits into the device and can be
you, but it’s important that you eat small, insulin to keep blood sugar levels normal. You changed when it’s finished. There are also pre-
regular meals. You need to reduce your intake may have heard it called mature-onset diabetes filled devices which are disposable and easier
of saturated fats. Try to make sure you include or non-insulin-dependent diabetes. for diabetics who have arthritis or are visually
carbohydrates in each meal. Beth: Oh yes, I think I have. impaired.
.
Mr Williams: Oh I know. My daughter is Nadia: Right , well, actually people of any age Beth: They would be much easier to use.
.
always on about that too. I bet I know what can develop Type 2 diabetes and although wouldn’t they ?
the next question is. it’s called non-insulin-dependent diabetes, Nadia: Yes, they’re much easier to use and
.
Marta: OK it 's about weight control. You really the treatment can include insulin. Of course, more convenient than syringes. They can even
should keep a close eye on your weight. How diet modification and oral hypoglycaemic fit into your pocket and look like the real thing
often do you exercise? medication is tried first , but sometimes it ’s !
You do still need a needle with this one. The
Mr Williams: Not enough these days. I used to necessary to have insulin injections. You needle is inserted on the end of the device and
walk along the beach with my wife . probably know that it isn’t possible to get
insulin in an oral form.
changed with each injection.
Marta: Mm. you told me last time that you ' d Beth: I see. and I suppose you still have to
stopped. Could you try to include some
physical activity in your daily routine ? It would
.
Beth: Yes I know that, but I've been reading
about new technology. What was it ? Oh yes,
Store the insulin in the same way ? It has to bo
stored in the fridge, doesn' t it ?
be a good idea to get back to walking along the insulin inhalers and insulin pumps. Nadia: Any unopened insulin can be stored
beach again. . .
Nadia: Mm yes they are looking very in the fridge, just don’ t let it freeze. Once the
. .
Mr Williams: Yes I suppose so. All right I’ll
make an effort to do that . Any other changes ?
promising. The inhalers look like asthma
inhalers, and the pumps are quite convenient
insulin is opened it can last up to thirty days
if it’s kept at a temperature of less than thirty
Marta: Yes, I've just got a couple more. What 's because you don ' t have to use a needle every degrees.
your alcohol intake like ? How many drinks do time you need your insulin. Beth: That’s easy to remember. Thirty degrees
you have per week ?
4.4 .
for thirty days. Thanks Nadia.
Mr Williams: I used to have a couple of beers
in the evening, but I have been having a few Nadia: There are basically three options for 4.5
more these days. giving yourself your daily dose of insulin. Peter: Christie, I'd like to tell you about Alice
Marta: Well , look , alcohol in moderation isn 't Beth: Oh, great. I didn't realise there were any Wilson. Alice came to the ward yesterday. She's
normally a problem . It can be a problem for options. been having a few hypos at home, so she's in
diabetics, though. You must keep a close eye Nadia: Yes, there are. There ’s been quite a lot for some investigations.
on your alcohol intake because it can affect of research into giving diabetics the easiest, Christie: She’s in bed twelve, isn't she?
your insulin dose. most convenient way of taking their daily
Peter: That's right. 85- year -old with a history
Mr Williams: Oh, all right. I’ll keep an eye on insulin. OK, let’s look at the first option. This
of Type 2 diabetes controlled with diet and
.
it as you say. Otherwise it creeps up on you , one is worn on the body all the time, that 's
medication . She 's on insulin bd while she's in
doesn’t it ? night and day. It's an insulin pump.
Marta: Yes, it does. Last question , it’s an Beth: How do they work ? with her diet, though.
.
here for stabilisation. Er she’s poorly compliant
important one. How many cigarettes are you Nadia: They deliver a steady flow of insulin Christie: Ah. That's right. I remember her. She
smoking at the moment ? throughout the day. They can push through can’t give up her cakes and pastries.
Mr Williams: A couple of packs a week . I know, both rapid and short-acting insulin - it doesn't Peter: Yeah , it’s always been a problem for
I know. I’m trying to give up. matter which - through a catheter which is her. I think we 'll have to give her some more
placed under the skin.
Marta: Cood for you . It is hard but it is diabetes education this admission .
important to stop smoking if you want to avoid Beth: I see. So you wouldn't be giving yourself
Christie: Mm. So what 's happening with her
circulation problems. a needle every time. BSLs?
Mr Williams: I certainly don't want anything Nadia: No, you wouldn't. That’s one advantage Peter: Right, well, she's on qds plus 2 am
like that . of the technology. The other upside is that it BSLs. We ' ve been quite strict about the times
can give you an extra, or bolus, dose to cover we take her blood sugar levels.
Marta: It 's quite hard to quit on your own. You
those times when you eat more carbohydrate,
might like to speak to your doctor about some
nicotine patches.
for example during a meal or a snack. The .
Christie: Right, I can see that. Um 7.30 am
before breakfast, 11.30 am before lunch, um.
real advantage of this is that patients have
Mr Williams: Thanks, I'll keep that in mind. A . 30 pm before dinner. Dinner comes at 5 pm
fewer large swings in blood glucose levels. The
on this ward , doesn’t it ?
main disadvantage is the cost. It's the most
expensive option. Peter : Mm , that’s right. We take the last one at
Beth: Mm. OK. What other options are there?
9.30 pm before bed time and , of course, the 2
am reading ,
98 Audioscript
: -:d sugar reading be?
.
- - stie: Oh. OK , Yes I see, What should her
5.1 Mrs Faisal: Right. Then what do I have to do7
= ter : Her BSLs should be between four and Frances: I'll just pull the curtains around so Frances: Then , take the lid off the specimen
-^
£ t millimols before meals and less than ten
we can have a private chat. Now, how are you
today, Mrs Faisal?
container like this. Don’t touch the inside of the
container when you take the lid off , or the urine
mil mols around one and a half hours after
meals Mrs Faisal: Not too bad , only I've got a lot of specimen will be contaminated by any bacteria
problems, er, when I go to the toilet. on your hands. Do it like this so that you keep
Christie: I see. What about in the evening at
Frances: Mm. Do you mean it hurts to pass your fingers away from the edge. Don't touch
bed time? What should it be then ?
Peter: It should be around eight millimols urine ? -
any part in here I mean, inside the specimen
container. Do you see what I mean?
around bed time.
Christie: What are Mrs Wilson ’s readings
?
Mrs Faisal: Yes. That’s right.
.
Frances: Yes the morning nurse mentioned
isn’t it ?
.
Mrs Faisal: Yes I see. That 's quite important ,
Peter: I'll go through her readings from something about it during handover. Tell me
what happens when you pass urine. Frances: Yes. it is. That 's to avoid
yesterday first . You can see here at 2 am
contamination from bacteria on your hands.
yesterday her BSL was four point eight. Before Mrs Faisal: It. um. burns when I go to the
Can you show me how you'll hold the specimen
oreakhist it was live point two. toilet, and I have to go all the time.
jar ?
Christie: Mm , 2 am four point eight and Frances: Right. So what you’re saying is
that
7.30 am five point two. She had a urinalysis it hurts when you ' re actually passing the Mrs Faisal: Sure. I'll take it like this, and take
done at 7.30 am , too ? urine, and you feel like you have to pass the lid off without touching the inside.
urine Frances: That 's great It's so important to do
Peter: That 's right. It was negative for glucose frequently ? Is that right ?
and ketones, Unfortunately, when her breakfast Mrs Faisal: Yes. It hurts when the urine comes the test correctly, otherwise we ll get a false
came she just picked at it and hardly ate out , and it’s worse because I feel I have to go reading. Now, pass some urine into the toilet
to and then pass a small amount of urine into
anything , Then she raced around trying to the toilet so often.
,
get to the shower before anyone else. You the sterile container. Try to catch the middle
can Frances: I know what you mean. It sounds like
imagine what happened! She had a hypo part of the urine stream. That’s why it’s called a
at 9 you might have a urinary tract infection.
midstream urine specimen. Do you understand
am and it went down to one point eight. Mrs Faisal: Oh. What did you call it? A urinary what I mean ?
Christie: Yeah, I see. Lemonade given and it . .. what was it? Mrs Faisal : Yes, I think so. Let me repeat what
went up to four point one. Frances: Its full name is urinary tract infection. I have to do so I ' m sure I've got it right . I pass
Peter: Mm. That ’s right. I gave her some We usually call it UTI for short. Have you ever some urine into the toilet and then some more
lemonade and a sweet biscuit and checked her heard of a UTI before ? urine into the container.
.
BSL again at urn, 11 , 30 am her BSL was fine, Mrs Faisal: Yes, I've heard of it , I think. Frances: Yes, that 's exactly what I want you
five point seven. At 4.30 pm it was seven point Frances: I ' ll phone your doctor about it in a to do. We want to get the middle part of the
one. We were quite pleased about that but in minute. He'll want you to do a urine specimen stream of urine. Just one more thing - tighten
the evening, at 9.30, it was up to fifteen. to send to the Pathology Laboratory for a the lid before you give me the specimen
Christie: Oh no! What happened? Culture and Sensitivity Test. That’s a test to see container, please.
Peter: It turns out that a well-meaning friend if there is any infection in your urinary tract. Mrs Faisal: Oh right , I can see why that’s
brought her a box of her favourite chocolates. Dr Sinclair will probably start you on some important .
The friend didn’t even realise that Alice was a antibiotics if the results from the lab show Frances: Mm. I’ll send the urine off to the
diabetic. you've got an infection. lab straight away, and we 'll get the results
Christie: That ’s incredible! I suppose it is Mrs Faisal: OK So you want me to do a urine tomorrow afternoon Is that explanation clear
difficult when you love chocolate. specimen, do you? or would you like to ask any questions?
Peter: I know it’s hard for her but something
will have to be done about it or she won'
.
Frances: Yes that’s right. I need to get an
.
Mrs Faisal: No, thanks. I understand I’ll go
t be MSU, or midstream urine specimen. Some and do that for you now.
able to manage at home. I rang the Diabetes -
people call it a clean catch specimen, because Frances: Just before you do the MSU , could
Educator and she said she'll see her tomorrow. you have to collect a urine sample from the you repeat back the steps for me so I can be
I’ve also asked the dietitian to see her so we middle part of your urine stream It’s better sure you followed my explanation?
can try to sort out what she does like eating. than collecting a sample from the beginning
That may encourage her to eat regular meals. of the urine stream , because there’s less .
Mrs Faisal: Yes, of course. First I ..
Christie: Are we testing her urine for ketones contamination. 5.3

at the moment? Mrs Faisal: Less contamination ? Frances: Hello , is that Dr Sinclair?
Peter: Yeah , while she 's having the hypos we’re Frances: Yes, the sample is less likely to have Dr Sinclair: Yes, it is
doing a daily urinalysis for ketones. bacteria from the outside of your urethra. I'll
Frances: Oh hello , it’s Frances from 8 West
Christie: And? go and get everything you need to do the MSU
and I'll be back in a minute to explain how to
. here. I’m calling about one of your patients,
Peter: Her urine 's been negative for ketones Mrs Faisal.
yesterday and today. do it.
Christie: All right. How was she today ? Mrs Faisal: OK , thanks. .
Dr Sinclair: Er Mrs Faisal? Can you remind
me ?
Peter: Much better, as you can see. At 2 am Frances: Yeah , she was admitted two days ago,
5.2
her BSL was still quite high, at eight point zero.
Frances: All right , here we are. I've brought er...
Christie: Well , that was to be expected, wasn’t everything you need to do the MSU. I ' ve got Dr Sinclair: Yeah, I remember. Isn't she in for
it? a sterile specimen container for the urine the removal of an ovarian cyst?
Peter: Yeah. It was six point five at 7.30 and specimen and some disposable wipes. Frances: Yeah , that’s the patient. I think
five point two at 11.30. We made sure that she she may have a UTI. She’s complaining of
Mrs Faisal: OK . So what do I do?
ate her breakfast today and didn ' t rush to the frequency, urgency and pain when she passes
shower. Frances: Firstly, wash your hands thoroughly.
Then you need to clean the area around urine.
Christie: I see she 's back on track now. A BSL Dr Sinclair: Right Is she febrile ?
the urethra from front to back with these
of five point nine at 4.30 pm and four point disposable wipes. Right, so step one is? Frances: Yeah , her temp 's up a bit. She's
eight at 9.30 tonight. around thirty -seven point eight. She doesn’t
Mrs Faisal: Ah, the first thing is to wash my
.
Peter : Yeah, that’s right Her 2 am BSL should
hands and then clean the area around my -
feel brilliant either general malaise.
.
be fine I'd say. She hasn't had any hypos today
urethra with these disposable wipes . Dr Sinclair: OK. She's got frequency, urgency,
.
at all
Frances: Mm, that’s it. You need to make sure pain and she’s febrile. Can you take an
Christie: Thanks. I'll keep an eye on her MSU and I'll come over and write up some
the area is clean so the urine specimen doesn't
tonight, though. antibiotics.
get contaminated with any bacteria from the
outside.
Audioscript 99
Frances: The MSU's already done, but I’ll takes a few minutes to get a reading. It doesn' t Mrs Kastel: Is that the tube which goes into
leave the Pathology Form at the desk to be have to be sterile and I don't have to send the your bladder ? I' ve seen a few around. You have
signed. Then we can send it to Pathology. I've specimen away. I can do the test here on the to carry a bag around with you.
encouraged her to increase her fluid intake, ward. Jo: Yes, that's it. The bag collects the urine.
too. Mr Zelnic: So it's not like that other test I did We call them indwelling catheters, or IDCs
Dr Sinclair: Great, thanks. I’m just on 8 East at when I had to be careful not to touch the inside for short. I’ve got one here to show you. An
the moment. I'll probably be up there in fifteen of the container. indwelling catheter just means a tube which
minutes. Everson: That's right. That was an MSU which is left in situ I mean, left in place. The tube
-
I sent to the lab to be tested for the presence is inserted through the urethra and goes into
Frances: Thanks. See you.
of infection. You had to be careful not to .
your bladder I inflate the little balloon on the
5.4 contaminate the urine specimen for that one. end, this one here, with water, and it sits at the
This is different. neck of your bladder. We have to be careful
Mr Zelnic: What happens if the kidneys stop
to use aseptic technique when we insert the
working properly ? Mr Zelnic: Right. I know I'll have to do a lot
catheter to reduce the risk of infection.
Everson: If the kidneys stop working properly, of tests. What did you say you are testing for
this time? Mrs Kastel: Oh. OK. So, er, you put the
renal, or kidney, disease could be the result.
tube in and blow that little balloon up so the
Um. kidney disease is also called renal disease. Everson: Oh, I' m checking for proteinuria: ah,
catheter doesn ’t fall out , and you have to take
The nephrons in the kidneys don ' t function that just means protein in the urine.
care how you put the tube in so I don’t get an
properly and your kidney becomes damaged. Mr Zelnic: I didn't know protein could be in infection.
Mr Zelnic: You mean the filtration tubes? my urine.
Jo: That’s exactly it. It's called aseptic
Everson: Ah , yes. The nephrons filter out the Everson: Um. protein shows up in the urine technique because it keeps equipment sterile
waste products in the blood . If the nephrons during kidney disease. to avoid contamination. The catheter bag
don' t filter properly, the waste products aren' t .
Mr Zelnic: Ah I see. you’re talking about is one of these. It’s a
removed . Eventually, toxic levels of waste Everson: We also check for haematuria, or transparent bag which collects the urine that
products build up in the blood. blood in the urine, as it can also indicate that drains out of the catheter. We empty the
Mr Zelnic: What about the urine? there may be a problem in your kidneys. And drainage bag three times a day.
Everson: At first, the output of urine drops. we check the pH of your urine, to see if it’s Mrs Kastel: OK. well I hope I won't need it for
Mr Zelnic: You mean what I' ve had ? I pass very alkaline or acidic. too long.
little urine at the moment. Mr Zelnic: That 's too technical for me. I'll give
- Jo: Oh, you shouldn ' t need it for too long at all .
-
Everson: Yes. It's called oliguria when
there 's a low output of urine. Oliguria can be a
you the urine sample right away if you like.
.
Everson: Thanks Mr Zelnic. Um , just ring when 6.1
symptom of the early stage of renal failure. If you want me to collect it. Natasha: Trish, have you got a minute? I just
the kidney disease is untreated , the nephrons need a drug check. I’ve got to give Mr Song
Stop working altogether and no urine is passed 5.6 some morphine.
at all. That 's called anuria, which means no 1 I'd like you to do it now, if that 's all right. Trish: Oh sorry. Natasha , I can’t at the
urine. 2 I need an ordinary sample of urine. moment. I'm just in the middle of something,
Mr Zelnic: Wouldn' t that be serious? 3 It takes a few minutes to get a reading. and I can' t leave it.
Everson: Yes, it is. Um. if your kidneys stop 4 I'm checking for proteinuria; that means Natasha: No problem. I'll see if Marek’s
working completely, your body can't get rid of protein in the urine. available. Um , do you know where he is?
extra water and waste products. Because your Trish: Um , I think I saw him in the first bay a
5 Ring when you want me to collect it.
kidneys aren ' t filtering out waste products or little while ago.
excess water, your hands or feet may swell; this 5.7 Natasha: OK , thanks. I’ll see if he's available.
. .
build-up of fluid is called oedema Ah you may
1 I'd just like you to do it now. if that’s all Excuse me, Marek.
also feel lethargic because your blood hasn't right. Marek: Yes?
been cleaned and can't function properly.
I just need an ordinary sample of urine.
This stage is known as end stage renal failure. 2 Natasha: Are you busy at the moment or can
Unfortunately, there's no treatment at this 3 It only takes a few minutes to get a reading. you do a drug check with me ?
stage of kidney disease. People with end stage 4 I’m checking for proteinuria: that just Marek: Sorry, Natasha. I' m tied up at the
renal failure have to go on dialysis or perhaps means protein in the urine. moment. They've just rung from Theatres. They
even have a renal transplant. 5 Just ring when you want me to collect it. want Mr Hubble prepped straight away. Can
Mr Zelnic: So how does the doctor know what's anyone else do it? I' ve got to do this pre-op
going on with my kidneys? 5.8 check right now.
Everson: You may not have any symptoms Jo: Did you buzz, Mrs Kastel ? Natasha: Thai’s OK. I'll have to ask Anna . She
during the early stages of kidney disease, but Mrs Kastel: Yes. Nurse, I'm really should be free. Hi , Anna. Are you free at the
there's a blood test which you’ll have to check uncomfortable here, um, I haven 't been able to moment?
how well the nephrons are filtering. We also do use this bedpan at all. Anna: I will be in a minute. I’ve just finished
a simple urine test to check for proteinuria, or Jo: OK. You mean that you haven’t been able this dressing. Just let me just clear the dressing -
..
protein in the urine. It's called a .
to pass any urine ? trolley first.
5.5 Mrs Kastel: No. I haven’t been able to go for Natasha: Great. Would you mind checking this
ages. morphine with me, please?
Everson: It's called a urinalysis and gives some Anna: Yes, sure. Let me just wash my hands
Jo: All right. Let me have a look . I’ll just
idea of the health of your kidneys. I’d just like
close the curtains. Do you mind if I feel your and I’ll be with you. Er, who’s it for?
you to do it now. if that's all right.
bladder ?
Mr Zelnic: Sure. What do I have to do? 6.2
Everson: Um , I've brought you a urinal - a
Mrs Kastel: No, that's all right . Natasha: Here’s the Medication Chart. It 's for
Jo: How does it feel here ?
bottle - for the next time you need to pass Mr Song in bed 16. There we are: Laurence
urine. Here it is. Ah , I just need an ordinary Mrs Kastel: Ow. Oh, it's quite uncomfortable. Song, and he’s ordered pethidine lOOmg IM
sample of urine. Jo: Mm, your bladder is quite distended. OK. four hourly.
Mr Zelnic: Oh. OK . In the bottle? You don't Now, you’ve still got some urinary retention Anna: Right, yeah , I can see that. Um,
want it in a special container? after your operation, haven't you ? Laurence Song, pethidine lOOmg IM four
Everson: No, no, the urinal is fine. I use a Mrs Kastel: You mean that I can't go to the hourly. When did he have his last injection ?
disposable dipstick to test the urine. It only toilet ? Natasha: He had it at eleven fifteen this
Jo: Yes, that’s right. I might have to put in a morning, and it’s, er. three thirty now, so that 's
catheter to drain the urine. at least four hours in between doses.
100 Audioscript
Anna: Uh-huh. 6.4 Helen: Yeah, right. I noticed that , too. He
Natasha: I've written up the drug book so it 's shouldn 't be taking that with atorvastatin.
Helen: Hello, Mr Albiston . How are you doing?
ready for us to sign. Do you mind getting the Mr Albiston: Not too bad, Helen . They started
.
I didn' t give it to him . Er you can see I
documented it in his notes.
pethidine from the cupboard? You've got the
keys, haven't you ?
.
me on a new tablet I think.
Sonia: That ’s good . He shouldn 't take Vitamin
Helen: That’s right. The doctor’s started you B3 - I mean , nicotinic acid - on its own or in
Anna: Yeah , that 's OK . I've got the drug keys on atorvastatin, so I thought I’d have a chat
on me. OK . pethidine lOOmg amps. Here they any other preparation
with you, as there are a few things you need to
are. I'll just count them That’s five. ten. fifteen, Helen: Right, I'll ask the SHO to cancel the
know about it.
sixteen, seventeen. I'll take one out for Mr order for the multivitamin tablet
Mr Albiston: OK . What do I have to know ?
Song and that means there are sixteen left. Sonia: That'd be great . Does he know not to
Natasha: Sixteen. That's right I’ll sign for it in
Helen: The medication is used to prevent drink grapefruit juice with the atorvastatin?
the book . Can you witness it for me, please? atherosclerosis, or clogging of the arteries with
fatty deposits. .
Helen: Oh yes. I explained all that to him
Anna: Sure. Um ... OK , there’s my signature. before.
Mr Albiston: I understand.
Natasha: Great. Here’s the amp - pethidine
lOOmg. I’ll just show you the expiry date ... Helen: You take the medication once a day as 6.6
expires oh four two thousand and ten. So it 's a tablet. Jo: Um. Beatriz , are you ready for me to go
still OK. Can you see that expiry date? Mr Albiston: Oh. right. Does it take long to through this medication assessment with you?
Anna: I’ll have a look . Pethidine lOOmg. OK , work ?
.
Beatriz: Uh huh.
Expires, um , oh four two thousand and ten. .
Helen: No it works quite quickly. I've brought a Jo : All right, here we are. Hello, Mrs Gilbert.
Looks good. diagram to help you understand what happens Do you mind if Beatriz gives you your
Natasha : Right , now where's the syringe ? Here
when you take this medication. After you medication as an assessment?
swallow the tablet it enters the gastrointestinal
we are. I’ll just draw up the amp so you can see
tract , or GIT. It passes through the oesophagus.
.
Mrs Gilbert: No dear. I don't mind at all .
it. There it is: two mils. Can you check that for Beatriz: Thanks, Mrs Gilbert. OK . I’m going
That’s this tube here.
me. please ? to follow the ’five rights’ of medication
Anna: Yes, that looks like two mils.
.
Mr Albiston: Mm the tube which leads to your administration for patient safety. Mrs Gilbert is
Natasha: Good, that's done. Thanks, Anna.
stomach .
Helen: That's right. The tablet passes into your furosemide.
.
ordered Lasix . Errn it's in her drawer here as
Can you come with me now and watch me give
stomach here, where it’s absorbed. It mixes
the injection to Mr Song? I know he’s been
with the liquids there so it can pass into your
.
Jo: Yes that 's the correct drug, but it should
waiting for it . have been ordered by its generic name,
bloodstream. It then goes into the liver via the furosemide, not its brand, or proprietary,
6.3 small intestine. name. Lasix.
Josh: Susanna, are you busy at the moment? Mr Albiston: That's this part under the Beatriz: Yes. it can be unclear sometimes,
stomach , isn’ t it? And it goes across to the liver
Would you mind checking a medication with
over here ?
.
can’t it? Um the medication is ordered for Mrs
me ? Eileen Gilbert. I'll just check the hospital label
Susanna: Sure, just let me put this chart back, Helen: Yes. The drug is metabolised, or on the chart Mrs Eileen Gilbert, so that’s right.
and I'll be with you. OK . I'm ready. chemically changed , in the liver. The liver stops If you don't mind, Mrs Gilbert, I'd like to check
the production of an enzyme which causes the your identity bracelet, too.
Josh: Right. It's for Chris Mutter in bed 1 . body to produce a harmful type of cholesterol.
Here’S his Medication Chart . By inhibiting this enzyme, the amount of 'bad
Mrs Gilbert: Why would you do that? You
Susanna : Let me see. Chris Multer, yeah, and know who I am ,
cholesterol’ which is released into the blood
.
bed 1 yeah . What's the medication you need is reduced. Atorvastatin also increases the .
Beatriz: You ’d be surprised Mrs Gilbert.
checked? amount of a type of ‘good cholesterol ' in your
Sometimes two patients with the same name
Josh: I need you to check his anticoagulant blood. This is a protective form of cholesterol , are in the hospital at the same time.
medication . He’s on warfarin at the moment. Mr Albiston: I see. So that’s why the doctor .
Mrs Gilbert : Oh fancy that!
.
Susanna: Mm warfarin. Yeah , that's what’s asked me if I had any problems with my liver. Jo : What route of administration do you have
written here. The liver is obviously very important in all this. to use?
Josh: And he 's taking it orally. Helen: Yes, it is. It's important to check if you .
Beatriz: Oral I suppose. The doctor hasn’t
Susanna: Peroral, yes, that’s correct . What have any liver problems before prescribing the written that in.
lime is it due? medication for you. Jo: That's a problem, isn 't it ? The doctor may
Josh: It’s due at sixteen hundred hours, so Mr Albiston: Yeah, I understand. Is it better to want to use the oral route or IV route.
that’s now. take it at night or in the morning? Beatriz: Ah , I see what you mean.
Susanna: Sixteen hundred hours. Correct. We Helen: Take it in the morning, because it’s Jo : What about the dose?
just need to check his INR before we give it. absorbed better in the morning than in the Beatriz: It's not written in. It’s usually AOmg,
don 't we? What was his INR result today? evening. but the dose would depend on her blood levels.
Josh: His INR s down to one point five. Ideally, Mr Albiston: OK , I'll remember that Jo : Quite right. You couldn't assume. It could
the doctors want it to be between two and two Helen: I’d also like to talk to you about some have dangerous consequences.
point five. Until it gets up to that level , he’ll be precautions you need to take when you're Beatriz: Mm. There 's a problem with the
taking 5 mg of warfarin ; then it can be reduced. taking this medication at home. frequency and time of administration as well.
Susanna: Yeah, poor guy He's been really sick, The doctor hasn 't noted down the frequency
hasn't he ? 6.5 the medication is to be given or the times.
Josh: Yeah, he has. All right, here's the bottle .
Sonia: Helen I wanted to talk to you about That’s a problem, especially with furosemide.
of warfarin 5mg. Can you see the label OK to Mr Albiston’s chart if you don’t mind. He’s just It’s usually given before midday in divided
check the dose ? started atorvastatin, hasn't he? doses so the patient is not troubled by getting
. .
Susanna: Yeah I can. Um it’s warfarin 5mg. Helen: Yes. A couple of days ago. I had a talk up frequently to go to the toilet in the evening.
Josh: I'm taking out one tablet. to him about some things he’ll need to be .
Jo: Well done. Now tell me. Would you be
careful of at home. happy to give this medication?
Susanna: Yep, one tablet.
Sonia: I can see on his chart when he started
Josh: I'll sign the medication chart first . There 7.1
atorvastatin. I'm a bit concerned about
we are. Dr Venturi: Hello, Paula . Are you looking after
something he was started on today. I noticed
Susanna: OK , let me countersign for you. that he was put on a multi B vitamin tablet. Mrs Boland today?
Right, that’s done.
Josh: Thanks. I’ll go and give it to him now.
.
Paula: No, that's Suzy but she's just gone
down to X -ray with a patient.
Thanks for the help.
Audioscript 101
Dr Venturi: Oh, I wanted to review Mrs Suzy: OK. I 'll get the infusion pump and set Angela: That’s why we check the cannula site
Boland 's IV fluids, it up. and take the cannula out at the first sign of
Paula: I’m looking after Suzy’s patients while Paula: Oh, and he 's also ordered some IV infection. Our hospital follows Evidence - Based
.
she's away Do you want me to pass on any antibiotics for her. Practice guidelines which suggest that we take
updates? IV cannulas out after seventy - two hours and
Suzy: Oh, right. I'll run them through a
Dr Venturi: Yeah, thanks. Could you take down secondary line. I don't want to run them that we change IV giving sets at the same time
Mrs Boland 's IV when it's finished, please ? through the primary line while she's got KCI as well. The number of days the IV is kept in is
Paula: Sure. I'll just write a note about it for running through it. recorded in the Care Plan.
Suzy. What about the cannula? Do you want Paula: Yeah , right. He also saw Mr Claussen.
it left in? You're looking after him , aren’t you? 7.4
Kasia: Good morning, Ward 7 West, Kasia
Dr Venturi: I think so. Leave it for another day
in case she needs some more fluids.
.
Suzy : Yes , he’s my patient Any new orders
speaking.
there ?
Paula: OK. Do you want to see Mrs Dillip in the Paula: Only that he said that Mr Claussen’s IV Dr Gonzalez: Hello, it’s Dr Gonzalez here. I'm
next room, too? cannula could be taken out. the Surgical Registrar I was bleeped about
Dr Venturi: Yes, I need to see her. According resiting an IV cannula.
Suzy: Oh.
to her blood results her potassium levels are Paula: He 's just finished his course of .
Kasia: I'm sorry I didn’t hear your name
quite low. I’ll put in a cannula when I finish my properly. Who’s calling , please?
antibiotics so he doesn ’t need it in any more. I
rounds. Could you start her on a litre of Normal
took it out for him and put on a light dressing Dr Gonzalez: It's Dr Gonzalez ... Claudia
Saline with 40 millimols of KCI ?
because he’s going home this afternoon. Gonzalez . I'm the Surgical Registrar for your
Paula: OK. Here’s the Prescription Chart for ward. I was bleeped about resiting a cannula
Suzy: Oh, thanks.
you to fill out . for Mrs Szubansky. Can I please speak to the
nurse looking after Mrs Szubansky ?
Dr Venturi: Thanks. That saves me a bit of leg 7.3
work. Can you run it over eight hours, please ? Angela : Hello , Mrs Boxmeer. Can I just check
Kasia : Sorry, urn, I didn’t catch the patient’s
Paula: Sure. One litre of Normal Saline with 40 name. Could you spell it for me, please?
that your IV cannula is all right before I put up
millimols KCI over eight hours. the next infusion? Dr Gonzalez: Yes, it's S- z -u- b-a- n- s-k- y. Do you
Dr Venturi: Oh . I ' ll have to order her some IV know who 's looking after her ?
Mrs Boxmeer : Oh, thanks. I was just going to
antibiotics, too. buzz you. The cannula hurts a lot and the IV’s Kasia: Oh, I know who you mean now. OK,
.
Paula: Yeah OK. We’ll run them through a not dripping any more. so you need to talk to Mrs Szubansky's nurse
about resiting a cannula. Urn ... Michael’s
secondary line. The primary line will have the
KCI running through , so we won' t mix the
.
Angela: OK it sounds like it might have
looking after Mrs Szubansky today. He’s just on
tissued. It’s when the fluid leaks into the tissues
solutions in the same line. and doesn’t drip into the vein . I’d also like to a break . Can I take a message for him?
Dr Venturi: Great. Now there’s just Mr check why it's hurting. Can I have a look ? Hrn, Dr Conzalez: Yeah . look. I'm pretty busy at the
Claussen left. How is he ? it’s quite warm, isn’t it ? .
moment I've got a few blood tests to do , but I
just wanted to check how urgent the call was.
Paula: He's one of Suzy’s patients, too. He's Mrs Boxmeer: Yes, and it looks red, too.
pretty good. He’s going home today, I think. Angela: So you' ve got warmth, erythema Kasia: Sorry, Dr Gonzalez . Er, would you mind
slowing down a bit ? Um , I’m afraid I' ve missed
Dr Venturi: Yes, that's right. He's ready for - -
that’s the redness and tenderness.
some of the message.
discharge. Can you take out his cannula before Mrs Boxmeer : Yes, it started being sore a little
he goes home, please? Dr Gonzalez : Right ... sorry. Could you please
while ago.
ask Michael to call me and let me know how
.
Paula: Yes, sure, we can do that I' ll pass on Angela: Sounds like an infection. I'll have a quickly the cannula needs to be resited ... um,
your instructions to Suzy when she gets back. look on your Care Plan to see when the doctor let me know when Mrs Szubansky’s next IV
7.2
.
put the IV in. Hm .. three days ago. OK. well antibiotics are due.
it’ll need to be resited anyway.
Suzy: Hi. Kasia: OK , let me just read that message
Mrs Boxmeer: What do you mean? back to you. You want Michael to call and tell
Paula: Hi , Suzy. You ’re back . Dr Venturi saw Angela: It means that I’ll call the doctor to you when the cannula needs to be resited and
some of your patients while you were at X- ray.
Mrs Boland first.
.
come and put in a new one I'll stop this drip when the next IV antibiotics are due?
now and take out your cannula. Dr Gonzalez: That 's right.
Suzy: Oh , OK . What are we doing with her IV ? Mrs Boxmeer : I thought that’s what you’d Kasia: OK. I’ll make sure I pass your message
Paula: He asked if you could take the IV down have to do. Why do I still have to have one?
when it’s run through . It 's just about through on to Michael. He’ll be back from his break in
Can' t they leave the cannula out ?
now. about five minutes or so. Er. can I get a contact
Angela: Sorry, you've still got six doses of IV number so Michael can return your call?
Suzy : Thanks. I ' ll take it down in a minute. Um. antibiotics so we need to put in a new line.
What about the cannula ? Does he want it left Dr Gonzalez: Sure, my bleeper number is 645.
Mrs Boxmeer: Right. OK. I hope they can find Thanks, Kasia.
in or taken out ? a more convenient spot to put it in.
Paula: He said to leave the IV cannula in for Kasia: You’re welcome.
Angela : I know it was a nuisance, and it was
another day just in case she needs more fluids. positional, too. Every time you lifted your arm 7.5
. .
Suzy: Oh all right . Um and what about Mrs the infusion stopped. The thing is that there is Cheryl: Karen, I'm just off to lunch. Do you
.
Dillip? Did he see her too? a lower risk of phlebitis if we put the cannula in
mind keeping an eye on Miss Hadfield’s fluids ?
Paula: Yeah , She’s quite dehydrated , isn 't she? your hand.
Karen: Sure, no problem . When did she have
Suzy: Yeah. And her potassium levels were Mrs Boxmeer : Phlebitis? Is that infection? the IV put in?
pretty low. too. Angela : Yes. It means inflammation of the
Cheryl: On admission yesterday. It was just to
Paula: He asked if you could put up a bag of vein . More often than not it's caused by a KVO while she was having her IV antibiotics,
Normal Saline with 40 millimols of KCI. He just nosocomial infection of staph, or staphylococci but she became dehydrated and still isn ' t
put in a cannula for it. bacteria . Staph is usually found on the hands. drinking much. That's why they had to increase
Suzy: OK. Can you check it out with me and I’ll The best way to prevent infection entering her fluids.
put it up straight away. is for health workers to wash their hands Karen: She was in a bad way when she came
properly before touching the cannula site and
.
Paula: Yeah I'm free at the moment. I'll check
to use aseptic technique when putting in a new
.
in wasn ’ t she ? What's up now ?
it with you.
Suzy: How long does he want it to run over ?
cannula . Cheryl: She's got an eight hourly litre of
Normal Saline up, but it's just through. Do you
Mrs Boxmeer: I see.
Paula: Let me look at the order. Um ... he mind checking out another bag with me? I can
wants it to run over eight hours. go to lunch then .
102 Audioscript
Karen: Sure. Have you got the Prescription Rebecca: Mm. yes. There’s also a problem with few days. I'm going to order you clear fluids
Chart with you ? the record of her urine output. She’s obviously for today. That means you'll just be on liquids
Cheryl: Yeah, here it is. Here's her hospital been incontinent - there are a few ‘wet beds’ today. Then you’ll be Nil By Mouth after
. ..
label .. Mabyn Hadfield . unit number 62388 recorded. See here at 4 am wet bed one plus
and at 8 am she had a wet bed two pluses.
midnight. I've got the Nil By Mouth sign here
which I'll put up a little later. It just reminds the
... date of birth 12 th January, 1920. kitchen staff not to leave you a meal
They can’t have been able to measure her urine
Karen: OK . Normal Saline - that 's the litre up
output with any accuracy. Mrs Clarke: Oh yes. That means I won' t be
now?
Casey: And according to the chart she hasn't able to eat or drink anything after midnight,
Cheryl: That 's right . One litre of Normal Saline
passed urine since lunchtime. That can 't be will I?
over eight hours. It went up at 03.00 hours
right. It says here she was ‘up to the toilet' Alexandra : No, you won’t . The reason for this
and it’s through now at 11.00 hours so I'll
write that in here. And I'll write in the amount at 1 pm. It really doesn’t look as though it is that when you have an anaesthetic , your
of a thousand mils. There. Now we can check was explained to her at all . At least she’s not muscles relax. If you have anything in your
out the next one. The date is 30th of May. showing any signs of urinary retention and stomach it could rise up into your throat and
the route is IV and the fluid is five per cent
she's not uncomfortable. you might inhale it .
Dextrose. Rebecca: And the drains were emptied and .
Mrs Clarke: Oh I see. I certainly don't want
.
Karen: 30 th , yes. IV yes, rive per cent recorded. that to happen.
Dextrose, yes. Casey: Well, there's no point adding up the
intake and output because of the mistakes so
.
Alexandra: No. not at all I ll get you to take
Cheryl: OK . We can check the IV infusion now. a special bowel preparation drink later to
Here's the bag. I'll just show you. Five per cent it won't be much use for assessing her fluid clean out your bowel. You’ll also need a small
Dextrose. It expires on the 16th of July 2010. status. enema to help you to open your bowels. This
Can you see the expiry date on the bag OK ? .
Rebecca: No it doesn't look like it . They'll have is so that when the surgeon operates, there is
Karen: Yeah. Five per cent Dextrose, expires to rely on her daily weight. less chance of contamination from the bowel
16th of July 2010. Correct. Casey: Let me see her Obs. Chart. Ah. yes. contents.
Cheryl: Right , so let me write it in. 30th May. They have weighed her daily, so that’s good. Mrs Clarke: It’s quite a business, isn ’t it ?
11.00 hours, The rate is one litre over ten Alexandra: Yes, it does take a bit of
hours. That 's easy to work out. One litre - a
8.1 .
preparation , Oh I’m going to do one last thing .
thousand mils - divided by ten hours. That’s a Alexandra: Hello, Mrs Clarke. I'm Alexandra. Mrs Clarke: I hope it won ' t taste awful .
hundred mils an hour. I'll be looking after you today. Have you settled Alexandra: [ laughs ] No, it’s not anything like
in yet? that. I'm gonna to get you some anti-embolic
Karen: Looks good.
Cheryl: OK . My initial here under Nurse one.
.
Mrs Clarke: Yes dear. I've met all the ladies in stockings. They're very firm stockings; you put
my room. I just have to wait for the operation them on to support your legs. You wear them
CA. now, don’t I? to prevent deep vein thrombosis - DVTs - or
Karen: And my initial here under Nurse two.
Alexandra: Yes. I'm going to look at the clots in your veins.
KB.
Cheryl: Thanks. Do you mind putting it up so I
operation list when it comes out later today so .
Mrs Clarke: That’s all right then They won't be
I can tell you where you are on the list. I just too much of a bother, I' m sure.
can have my break now ? need to go through some pre-op things with
.
Karen: No go ahead. I’ll put it up for you. you. Is that okay? 8.2
Cheryl: Thanks. .
Mrs Clarke: Yes, that's fine. Um I’ve brought .
Alva: Hello I'm Alva. I'll be looking after you
my letter from the doctor for you. Here it is. today, er. Ms Slade. Do you mind if I call you by
7.6 .
Alexandra: Thanks Mrs Clarke. Right, let me your first name?
Rebecca: Look at this Fluid Balance Chart . see. First. I'll check your consent form. Is that .
Emma: No. Hi Alva. Nice to meet you. Please
Casey. It's a mess! your signature? call me Emma ,
Casey: I see what you mean . Whose is it? .
Mrs Clarke: Yes dear. I signed it in the doctor’s .
Alva: OK thanks. I always like to ask first .
Rebecca: It’s Miss Stavel's. You remember, surgery before I came to the hospital. He .
Um I wanted to have a talk to you about your
she's the one who lost a lot of blood during her explained all about the operation to me. operation tomorrow.
operation. .
Alexandra: Good. Now I' ll get you to take off Emma: Oh. Is everything all right ? There’s
.
Casey: Yes I remember. What's her oral intake your nail polish later today so the anaesthetist nothing wrong, is there ?
like? will be able to see your nail beds.
Mrs Clarke: Oh.
. . .
Alva: No no not at all everything’s fine. I'll
just bring this chair up so I can sit with you.
Rebecca: It's hard to tell. There’s no record
of any intake from 10 am to 5 pm. I don’t Alexandra: And you’ll also need to shower Um. there are no problems. I just want to go
know if she drank anything at all. And at 5 pm with this antiseptic wash . Here 's a sachet of through what will happen when you come back
they recorded the amount of water she drank the wash for you. Just wash all over using the to the ward after the operation . People always
inaccurately. It was recorded as 'half a cup'. It's antiseptic wash as you would with soap. feel better when they know what to expect .
impossible to know what size cup! Mrs Clarke: All right. I'll do that tonight before .
Emma: Oh. yes you’re right. I' m so nervous
Casey: Right , I wonder if they explained how I go to bed. about the operation. I haven't been in a
the chart worked to her before they started Alexandra: Great. I'll get you to have another hospital since I was a kid. when I broke my leg.
it. Otherwise you can 't expect her to comply shower with the antiseptic wash in the morning. Things have probably changed since then.
at all . I'll give you another sachet in a while. Alva: Well , hospitals have changed a bit but .
Rebecca: I’m not sure. Mrs Clarke: Will my tummy be shaved before don't worry. I’ll go through it all now. and you'll
Casey: What about her IV intake? the operation? have the opportunity to ask as many questions
as you like.
Rebecca: Her IV intake 's been recorded .
Alexandra: No it won' t. We used to shave the
Emma: Thanks. I feel silly being so worried. I' m
accurately. She's had a few litres today. operation area but the policy has changed now.
They did record the extra fluid given with IV not normally like this.
Mrs Clarke: Oh.
antibiotics correctly. Alexandra: Best practice is that if it doesn't .
Alva: That’s OK Emma. It's quite normal to
Casey: What about her output ? What's that feel a bit apprehensive. Um , I'll try and cover
interfere with the surgery, then the area is not
everything so you're prepared for what'll
like? shaved.
happen after the operation. Um. I see you' ve
Rebecca : She’s been vomiting a lot, as you can Mrs Clarke: Oh good. I remember having it
.
see but they haven 't been able to measure it
properly every time.
done many years ago when I had an operation.
brought the leaflet about keyhole surgery.
Emma: Yes, um , it was sent to me at home
It wasn' t very comfortable.
last week. The only thing I know is that I won 't
Casey: It 's hard to know what ' large amount' or Alexandra: I know what you mean. A lot of
'small amount ' means, isn 't it ?
have a big cut so the operation won't leave a
people used to complain about it. Now, I see big scar. I’ll just have a couple of small holes in
that you've been on a low -residue diet for a my tummy.
Audioscript 103
.
Alva: That 's right . Um keyhole surgery is also Emma: Ah . right. That ’s the third factor. As the blood slows, it
called minimally invasive surgery because it’s
performed with the use of a laparoscope, using .
Alva: The machine automatically blocks it or becomes stickier and blood clots form quite
locks it out. Um. the nurses will be taking your easily in the lower legs.
small incisions or surgical cuts. Um , you 'll obs. - I mean, your observations - like your
probably have three to four puncture sites. Mr Vitellis: Is that why my lower leg started
temperature, pulse and blood pressure. They’ll to hurt?
These are just small holes made near your
also check your pain level. Erm, they'll check
navel. And you' ll have a small dressing covering all these frequently, so they'll keep a good eye
Nasreen: Yes, calf pain is one of the signs of a
the holes made during surgery. It's just a light DVT. The other signs are warmth and swelling.
on you.
covering to keep the area clean until it heals. Mr Vitellis: Mm, it certainly is painful: it's still
Emma: That's a relief . I think the fear of being quite warm, too.
Emma: Oh.
in pain was making me unable to cope with the
Alva: During the operation, the surgeon uses idea of surgery. Is there anything else that I’ll Nasreen: Mm, look at the picture in the middle
a laparoscope, which is passed through the have to do after the operation?
of the diagram : it shows a blood clot forming in
holes to visualise your gallbladder. The infected a deep vein. And if you have a look at the last
Alva: Just two more things. I see the physio
gallbladder is removed through the largest picture, you 'll understand why you’ve already
has given you an incentive spirometer , er, a
puncture site. You'll have a mini- drain which started taking anticoagulant medication. That's
tri -ball , to blow into. medication which stops any more clots from
will only stay in for a couple of hours. It's a
Emma: Yeah . forming.
small plastic container attached to some tubing
which takes away any excess blood from your Alva: You’ll have to use the tri-ball every hour Mr Vitellis: Oh. so the last picture’s not a
wound. that you are awake. DVT ?
Emma: Ah-hah. There won 't be lots of blood, .
Emma: Yes she’s had me practising every hour.
I've been trying to blow harder each time but
.
Nasreen: No it shows what happens if the DVT
will there ? I can’t stand the sight of blood. is not treated. Around seven to ten days after
Alva: No. not much, but I can make a note for it’s quite difficult. the original thrombus, or clot, has formed, a
the rest of the staff to cover the drain for you .
Alva: Yes it is quite hard. Um, the physio would piece of the clot can break off and be carried
so you don ' t see any of it. have told you how important it is to use this along in the blood vessel . A blood clot which
to prevent lung collapse, by making sure your breaks off is then called an embolus.
.
Emma: Thanks. Um will I have a drip in my
lungs inflate as much as possible Mr Vitellis: Yeah, yeah. I've read a bit about
arm? .
Alva: Yes. you will. You 'll come back with an IV . .

Emma: Yes she did. Um I understand it 's them. They ' re dangerous, aren’t they?
and some fluids running, just until you can eat to get your lung function back after the Nasreen: Yes. they are dangerous when
and drink again. anaesthetic. they get stuck in blood vessels and block the
Emma: Will I be able to eat straight away? blood circulation . The condition is called an
8.4 embolism. The type of embolism which is most
Alva: You’ll have had a tube down your throat Nasreen: Hello, Mr Vitellis. How are you
Tor the anaesthetic , so we ll need to make sure
dangerous is a pulmonary embolism , because
doing? Everything all right? it can block the blood flow to the lungs.
that your swallow reflex is working again after
Mr Vitellis: Yes, thanks. Nasreen. I'm fine. Mr Vitellis: I can see why my DVT is being
the tube's been removed. We check that you
I was just wondering if you could explain what 's treated fairly aggressively.
can swallow again by trying you with a few ice
happening about this clot in my leg.
chips. As soon as you can manage the ice chips, Nasreen: Yes. I’ ve taken the anti-ernbolic
Nasreen: Oh, sure. I can explain it to you. I'll
.
we’ll give you small sips of water. Um we ' ll also
get you one of the ward brochures which help
stocking off the leg with the DVT but you still
need to keep a stocking on the other leg. I'll
need to be sure that your bowels are working
again before you try eating small amounts of explain it very well. Just a minute. Starting with come back in a little while and talk to you
food. the first picture, this shows normal blood flow about the medication you'll be taking.
as it moves smoothly through your arteries and Mr Vitellis: Thanks. Yeah, I'd like to understand
Emma: Oh, is that why they do that ? I never
veins. Strong muscles surround the deep veins about that , too.
knew. It makes sense to go slowly.
and help to pump the blood back to the lungs
Alva: The other tube you’ll have is an where the blood is oxygenated again .
indwelling catheter, which they'll put in while
8.5
Mr Vitellis: I see. So why does a clot form ? Viki: Hello. Belinda. Er. they’ve just called from
you are in Theatres. Um, it can be taken out
Does something happen to the blood flow ? The Theatres and asked me to prep you. I’ll just
when you 're back on the ward and think you
doctors explained that lying flat for a long time
.
can void again - um I mean, pass urine. Um
you won' t have the catheter for too long. Now,
. doesn’t help blood flow much.
go through this checklist with you. and then
I’ll give you a pre-med to relax you a bit, OK ?
I'm just going to get something to show you so Nasreen: Yes , that's right . Orthopaedic Feeling all right?
I can go through the rest of the information. operations take a long time and so patients lie Belinda: Yes, I think I’m OK . The evening nurse
flat on the operating table for several hours. went through everything about the operation
8.3 This gives them a higher risk of getting a DVT with me last night so I know what to expect.
Alva: OK . Emma, er, can I go through the rest than patients undergoing operations which
of this post -op information with you now ? last a shorter time. In surgical cases there are .
Viki: Good. Now first of all I'm going to verify
who you are, including your hospital number.
Emma: Er, yeah, thanks. Actually, there's
three factors which contribute to the risk of
You'll be asked the same information by lots of
something that concerns me a lot. Um , what
DVT occurring during or just after surgery. The
people along the way. Don’t worry, it’s just our
first factor is caused by patients lying without
about pain ? I'm worried that I'll be in a lot of checking system. Ah , now, can you tell me your
moving on the operating table. Because the
pain . body is immobile for so long, blood flow is
full name, please?
Alva: You'll have a PCA machine to use for any slowed and the blood doesn 't return to the Belinda: Sure. Belinda Anne Mainwaring.
discomfort after the operation. That's what heart as efficiently as usual. Blood starts to Viki: Can I check your identity bracelets, too ,
.
I wanted to show you so I' ve brought one
along for you to see what it’s like. It 's patient-
pool, or collect , in the lower legs. This pooling please ?
of the blood in the veins is called venous stasis. Belinda: Yes, here they are. I’ve got two on.
controlled analgesia which will be run through
Mr Vitellis: I see. Viki: Thanks. Belinda That’s six seven four nine
an IV line and a pump. The medication goes .
oh three, er, correct on both of them. Can you

Nasreen: The second factor is a result of the
into your bloodstream whenever you push this tell me what operation you’re going to have?
venous stasis. As the blood flow slows, the
button.
veins stretch. This is called venodilation. The Belinda: Oh , um , they 're going to fix the
Emma: Oh. Er , so I won’t be in pain. I was
really worried about that. But what if I keep
stretching of the veins causes damage to the tendon in my right shoulder .
inner wall of the veins. Gradually, small tears Viki: Right, so that's a right shoulder
pushing the button? Won’t I give myself an appear. arthroscopy for a rotator cuff repair. Er,
overdose?
Mr Vitellis: Oh , I didn't know that. great. Have you signed a consent form for the
Alva: No, don ' t worry. We program the pump
so there’s a lock -out time. Even if you keep .
Nasreen: Mm the tears in the vessel walls operation?
activate a clotting response to the tissue injury. Belinda: Yes, I signed it yesterday.
pushing the button, no more medication will go
through the line. Viki: I’ll just show you this signature. Is this
your signature ?
104 Audioscript
Belinda: Er. yes, that's my signature. Belinda: Er, I had dinner last night at , what. 6
Viki: OK , now did the surgeon come up and pm, I think, and a last drink of water at 11 pm .
came in after an RTA, er he had the motor bike
accident this morning.
mark the operation site? before the nurse put up the Nil By Mouth sign
Georgia: Ah huh
Belinda: Yes, look , I’ ve got pen marks on my and took the water jug away.
right shoulder, Viki: That’s good. As long as you have the last
Hazel: He’s had a splenectomy today at 11.15
am. The operation was uneventful. No post
Viki: Yes, you have. Er, right , now I've got drink at least six hours before surgery. You
op complications, except a bit of delayed
..
all your charts together - um Drug Chart ,
Prescription Chart for fV fluids Patient Record
don't want to risk vomiting after your surgery.
All right , I'm going to give you your pre- med
awakening.
. .
and Fluid Balance Chart So I’ll tick that
section , Um , have you had any X- rays done in
now. Georgia: Mm. He’s still a bit drowsy, isn’t he?
Belinda: Er. pre- med? Does that mean I'm Hazel: Yes, a bit. I put him on neuro obs. to
hospital? going to sleep now ? keep an eye on It. I’ve pul the chart in his
in.
-
Belinda : Yes, I had an X ray when I first came
.
Viki: No it's not an anaesthetic. You'll just
calm and relaxed.
feel
notes. His GCS was ten out of fifteen at first .
He was opening his eyes to pain, making
Viki: Right. I'll get them and add them to your incomprehensible sounds and obeying
Belinda: That 's good.
chart , which we 'll take down to Theatres. Do commands for movement . When he left
Viki: There you are. Now. I’ ll just sign the Recovery, his GCS was thirteen out of fifteen.
you have any allergies?
Checklist and we'll wait for the porters to take He opens his eyes to command, Roli, can you
.
Belinda : Er, no not that I know of. you to Theatres. open your eyes for me ?
Viki: OK. that 's a 'No’ for allergies. And. er I'
circle ' No ' next to ' Red bracelet worn’ as you
.
ll
8.6 Roli: Urgh.
don 't need one. Now, on to your teeth. Wendy: Hello, I'm Wendy. I'm a Theatre Nurse Hazel: That’s it Do you know where you are
Do you Roli ?
have any caps on your teeth , or crowns, or and I'm going to check you in today. How are
bridges? you doing? Roli: Um. hospital .
Belinda: No. I don 't. Belinda: All right. Georgia: That's it , you’re back on the ward.
Viki: OK . I can write ' No ' for that , too. You Wendy: That's good. I'm just going to go Hazel: Right his obs. are stable, temp thirty
,
don' t have dentures either, do you? through this Checklist again. OK ? Um. I six , pulse seventy - two , BP one twelve over
sixty- four, oxygen sats are ninety-seven per
Belinda : No, all my own teeth . know you’ve already answered many of
these questions, but we like to double-check cent on three litres of oxyeeri.
Viki: Yeah , I thought so , but we have to ask
to be sure. The operation site wasn ’t shaved, .
everything OK ? Georgia: I’ll just switch over to our oxygen ,
Roli. I’m changing the oxygen tubing over to
was it? Belinda: Yes, that's fine.
our wall unit. Can you just breathe normally
.
Belinda: No the surgeon just came and Wendy: Right, can you tell me your full name,
for me ?
marked the operation area. please?
Roli: Mm , yeah. OK
Viki: Right. Er . have you taken off your nail Belinda: Yes, Belinda Anne Mainwaring.
Hazel: That 's it OK fluids. He's got a litre of
varnish ? Wendy: Thank you. I'll have a quick look at
five per cent dextrose running.
Belinda: Yes, er. I did that this morning. Why your identification bracelets if I may ?
do you have to take it off? Georgia: Right. I’ll just transfer the bag to our
Belinda: Sure, here they are.
IV stand now. There we are.
Viki: It’s to minimise infection and also to make Wendy: Belinda Anne Mainwaring, number six
Hazel: That litre is due in an hour or so,
it easier to check your circulation while you 're seven four nine oh three, correct. Can you tell
and there are more fluids written up on the
under anaesthetic. Um. I need you to take off me what operation you're having today ?
any jewellery you have. Metal is also a safety Prescription Chart. Er, Roli had a few episodes
Belinda: Yes, I' m having the tendon in my right of vomiting post -op , so you might like to keep
risk in Theatres. shoulder repaired. the IV going for a while. He was given an anti-
.
Belinda : Oh I didn' t bring any jewellery to Wendy: Mm. did you sign a consent form for emetic and he has a prn order in case he has
the hospital, but I don’t really want to lake my the operation? any nausea later on
wedding ring off.
Belinda: Yes, I did. Georgia: Great. Er, what about drains ?
Viki: That's all right. I'll just tape it on securely Wendy: Is this your signature on the consent Hazel: He’s got one redivac in situ . Roli , can I
so the metal is covered. form? have a look at your drain for a minute ?
Belinda : Thanks.
Belinda: Yes, it is. Roli: Yeah. OK.
Viki: OK. Next question. Do you have any
Wendy: All right, nearly finished. Have you had Hazel: Here it is. It's patent. Let's just have a
piercings?
a pre-med? look. Yes , it 's working well . And it 's draining
Belinda: No, I don't. small amounts. It 's to be removed when it
Belinda: Yes, I had an injection just before I
Viki: Right , so that 's also ‘N/ A’ for piercings came here. drains less than twenty mils a day
- it’s not applicable to you. I’ve nearly finished Wendy: Mm, pre-med given and signed for. Georgia: OK. OK
the questions. How are you doing? Can I keep
going?
.
Great All right. I 'll sign the Checklist and Hazel: Roli. can I check the wound now ? I'll
you've already got a theatre cap to cover your just take the blanket off for a minute. There it
Belinda: Yes, I'm OK . I feel quite relaxed . hair. You’ll be waiting here for a few more is. The wound was closed with clips, as you can
Viki: Right , I can see you’ve got a theatre gown minutes and then we'll take you through , Are see. There are just six clips. The wound's been
on. Have you got your anti -embolic stockings you all right there ? covered with a non -adhesive dressing. Leave
on ? Belinda: Yes, thanks. it intact until review by the surgeon tomorrow ,
Belinda: Yes, here they are. on nice and please.

smoothly as you showed me. I' ve even put on 9.1 Georgia: OK. Er , what about analgesia?
the disposable knickers you left me. Hazel: Hello, I’ve got Roli Davidson back from Hazel: He’s been ordered pethidine seventy-
Viki: Good work. Er, ah . when was the last time Theatres. Are you taking over his care ? five mg IM three hourly for three days, then
you passed urine? . .
Georgia: Yes that's me. Hello, Roli you’re back oral analgesia. He was given pethidine seventy-
Belinda: About five minutes before you came
to check me. So, ten twenty I think ,
on the ward now from Recovery. Can you hear
me?
five mg just before leaving Recovery at. er
1.30 pm. I gave him an extra blanket, too, as
.
Viki: OK, last void was 10.20 am. Let me Roli: Mnnn. he was a bit hypothermic.
see. I need to circle 'N/ A' next to cathetcrised Georgia: I'll just get a quick handover, and then Georgia: Right. Thanks. Are you feeling warm
because you don’ t have a catheter. Now, when I'll help make you a bit more comfortable. OK ? enough now. Roli?
was the last time you had something to eat or
drink ?
Roli: Mnnn. .
Roli: Um , yeah I'm OK now. Just sleepy.
Hazel: OK , Georgia, I'll just go through the .
Georgia: All right I'll just put your notes back,
operation report with you. Um. Roli Davidson and then I'll come and take a few obs. and
make you comfortable.
Audioscript 105
9.2 Patricia: OK. Can you tell me if the pain is the Bev: Yeah. I remember. A& E was full after the
Georgia: Hello , Roli. I 'll just do some more obs. same all over or different? match finished.
and see how you're doing. Paul: I've got a throbbing headache, and my Patricia: He's in a lot of pain, and we're giving
Roll: OK. right cheek hurts when I touch it. him regular morphine. He's got a past history
Patricia: That'll be because you've got a
-
Georgia: OK, temp thirty six one, pulse sixty -
broken cheek bone. The pain is referred to your
of drug abuse. The trouble is that you hear him
on the phone to his mates telling them that
eight, BP a hundred and six over sixty, and
your oxygen sats ninety -six per cent on three head and you get a headache. it’s great, he gets the injections every time he
litres of oxygen. I’ll take the oxygen off in a .
Paul: Oh OK . That makes sense. wants and he says he 's stoned all the time.
little while, OK ? Your temp's still down a bit. Patricia: What about the pain in your arms Bev: OK. That’s difficult, isn't it? I’ll keep an
Are you warm enough now ? and chest ? eye on it. When did he have his last —
Roli : [ incomprehensible! Paul: It's a stinging pain in the shallow cuts, Mark Fellows: Hey you , nurse. Yeah , you.
.
Georgia: Sorry Roli. I didn’t catch that. I'll just but this cut in my chest is quite deep, and the
pain 's like a knife.
Give Paul his injection now. Can ’t you see he's
in pain? You nurses don 't do a bloody thing
take your mask off for a minute.
. .
Roll: No not really. Um I'm still feeling cold. Is Patricia: When’s the pain worse, Paul? round here. He’s in pain and he’s giving me
grief about it. I can't do anything about it. It 's
that normal? Paul: It’s worse when I turn over or move.
not my job.
Georgia: Yeah, it's OK. It 's called hypothermia. Patricia: OK, can you rate the pain for me ? On
It happens sometimes if the operation takes a a scale of zero to ten , zero is when you feel no Bev: It 's OK, I’ll see what I can do. I' ll be
long time. I’ll get you an extra blanket to help pain and ten is when you feel the worst pain looking after Paul this evening. Can I ask who
warm you up. Are you quite awake after the that you can imagine. What’s the pain like now you are first , please?
operation? you are at rest ? Mark Fellows: I 'm Mark Fellows. I’m Paul’s
Roll: Yeah . I'm awake now, um. but I still feel a Paul: It’s around six . uncle. Don’t worry about who I am. Do
bit groggy something for him. He’s in real pain, and you're
.
Patricia: And when you move a bit ? just sitting there doing nothing.
Georgia: That's because you’ve had an Paul: It gets worse. Seven, at least.
anaesthetic . You ’ll feel better soon. Patricia: All right, I’ll get you something for
.
Bev: All right Mr Fellows. I need you to lower
your voice so we can talk about sorting out
Roli: I hope so. My throat feels really sore. It’s
hard to swallow.
.
the pain. Now I notice you've been ordered Paul’s pain. OK ? I can’t understand what you’re
paracetamol four hourly. saying if you shout at me.
Georgia: Don’t worry, that’s normal. It's just
caused by the tube they put down your throat
.
Paul: Yeah I don ' t want it. It ain 't strong Mark Fellows: Yeah . OK , OK . Sorry. Look,
enough. it's just that he needs something for the pain.
during surgery. I’ll get you some ice chips to
suck soon. Patricia: No , not on its own, but they order You’re just sitting there. You know, you could
it for you because it works with the opioid bo doing something to help htrn. Why don 't
Roli: Thanks. I don't think I could manage painkillers to reduce the amount you need to the nurses ever get him anything? He’s always
anything else. I feel like I ' d be sick if I ate take. complaining he’s in pain.
anything.
Paul: Er ? Patricia: I do understand, it’s hard, isn’t it ?
Georgia: Mm, nausea is sometimes a reaction
Patricia: I mean, it reduces the number of You feel very helpless when you see someone
to post -operative pain. I'll keep an eye on that. injections you need to have by twenty to thirty in pain and you can' t do anything about it
How's the pain level now? yourself.
per cent. It 's important to keep taking the
.
Roli: Oh I’ m in bad pain, and everything hurts. paracetamol regularly. Mark Fellows: Right.
Georgia: That’s, that’s quite normal. Patients
who’ve had abdominal surgery are often
.
Paul: Ob I see. That’s different then. Patricia: You’re worried that Paul isn’t getting
Patricia: Is there anything else which relieves regular pain relief , is that right ?
in quite a bit of discomfort. I’ll get you an the pain?
injection for the pain . Mark Fellows: Right.
Paul: One of the nurses gave me a heat pack Patricia: How about I get his chart now and
Roli: Good, thanks a lot. I feel like I can’t move
for my chest , and that helped. see what he' s been having. I can see if he 's due
because it 's going to be painful.
Patricia: All right. I'll get the painkillers for you for something now. All right?
Georgia: Mm , it 's quite common to avoid any
and try and put you in a comfortable position Mark Fellows: Yeah , yeah, all right. Look,
movement which might cause discomfort, but
it ' s important that I help you to move around
with some more pillows. I’ll get a heat pack
too.
. sorry, sorry, nurse. I shouldn't shout at you. It’s
just that. well, he lives with me, you know. I'm
and change position.
Roli: Oh , I can hardly wait for that! It 's strange Paul: Thanks. I'll try to get some rest. It's hard more like his father. I hate to see him like this.
I feel as if I want to go to the toilet all the time
. to sleep when you're in pain. Patricia: Don’t worry, we all have to let off
. Patricia: Yes , it is. I'll pull the curtains around
Georgia: It 's quite usual to have that sensation,
and dim the lights a bit for you as well. There
.
steam sometimes. As I said before Paul is
getting regular pain relief. I’ll come and talk to
even though you've got a catheter in your
bladder Sometimes the catheter needs a little you go. him about talking to his nurse before the pain
adjustment so it's more comfortable. gets too bad. If he’s still in pain after he has
9.4 an
injection, he needs to let us know, and we’ll
Roli: I feel dizzy, too. It’s like I'm going to fall see
Patricia: Bev. do you mind if we sit here at the about having the order reviewed.
out of bed.
Nurses’ Station while I hand over my patients ?
Georgia: That’s OK . It takes a little while to be I just want to keep an eye on Paul Vargas over
Mark Fellows: Can you do that ? I mean I
thought he just had to put up with it?
.
orientated again after an anaesthetic. I’m going there. I've been watching him with his visitors, Patricia : No . It 's really important that Paul lets
to put these bed rails up while you're feeling a and I think it's a good idea to be close by.
bit wobbly and get you some pain relief . Here's us know about these sort of things because we
They’re getting a bit loud by the sound of it. can help before things get out of hand.
the call bell if you need me. I think it’s a good idea to watch the situation
Roli: Thanks. Mark Fellows: Oh. OK . I hope you won’t take it
in case we have to defuse it and calm things
out on Paul just 'cos I lost it.
down.
9.3 Bev: Oh , that’s fine. I noticed a lot of visitors .
Bev: Of course not Mr Fellows. Being in
hospital Is very stressiul , especially for
Patricia: Hello. Paul. How are you feeling now ? .
around the bed and their voices seem to be parents, and it sounds like you're more like
Paul: Oh, not too good. Everything hurts. getting a bit louder, don 't they ? a dad to Paul than an uncle. Don’ t worry, we
Patricia: Mm , I can imagine. You’ ve got a lot Patricia: Mm , yes, they do. Well, let's do this understand.
of cuts and bruises. Can you tell me where the handover while we keep an eye on them. Paul’s
pain is ? a 19- year -old who got a fractured zygoma 9.5
Paul: Yeah. My head, my cheek . . um the .
broken cheek , I mean. My arms hurt where the
. with multiple lacerations on his chest after a
drunken brawl after that football match at the
Sonia: Now, post-operative pain is acute
pain , and with the correct management
cuts are and my chest hurts, too. weekend. should decrease over a few days or so after
the operation, depending on the individual
106 Audioscript
Sharon: I’m going to show you my sad and hospital it was well over the initial three hours
patient 's pain tolerance. It 's important to be
happy faces. They're very useful for kids who From the onset of the stroke. She's been with us
clear abouL pain threshold and pain tolerance.
The pain threshold is the point at which we can't talk because they’ve got a sore throat. for two weeks now and has been working really
all feel pain , for example the temperature You just have to point to the face which looks hard with everyone so that she can get back
like the way you feel. Is that a good idea ? to her own home. The purpose of this meeting
that water reaches when it is felt as burning
or scalding pain. Pain tolerance is a more .
Anton: Mm yeah. is for us to report back on what we 've all been
doing for Lidia . Then we need to finalise her
individual sensing of pain and can be affected
by several things, like cultural factors for
.
Sharon: OK Anton, here are the faces. Can discharge plan. William, do you want to kick
you see this face here, this first face. Can you
instance. Some patients have a high tolerance off?
see he's smiling?
for pain and some have a low tolerance for William: Mm. I examined her yesterday, and I
Anton: Mm.
pain. feel that she 's doing well, medically. I've spoken
Sharon: He feels great. Nothing hurts. The
Nurse 1: This would be why we ask for patients to Lidia, and she seems keen to go home. She
next face feels pretty good, but it hurts a little struck me as a very independent person, too.
to assess their own pain level on a pain scale. bit. He can put up with it. I asked her about her goals and going home
It ’s quite subjective
Sonia: Mm , that ’s right. Now, I 'm going to talk .
Sarah: I see the faces relate to the pain level , seems to be top of the list.
about the different analgesics which are used Sharon: That's right . We like to use the Andrea: Yes, she 's spoken to me about how
in acute post -operative pain . Analgesics act on Wong-Baker chart, or faces chart, with our she was managing at home before the stroke.
different sites of the body and are therefore younger patients. Any child from the age of Her daughters are very supportive, too, which
useful for the various types of post-op pain around three can use this chart. It's also useful will be good. She’ll need a lot of help with her
which we talked about earlier. for patients who can' t express themselves well ADL5. Kim , how did you find her?
enough in English to explain their pain level.
Nurse 2: You mean localised and referred Kim: I agree with both of you. She’s been
Now then, Anton, if you look at face number trying really hard , She’s been doing all the
pain?
three, he 's starting to look a bit sad. isn't he ?
Sonia: Yes. We talked about fast pain which is physio exercises I give her. It's just ... I'm a
He's got quite a lot of pain. It hurts when he
felt at the site of the surgical incision - that little concerned about her ability to perform
moves about. And look at number four. Can the basic ADLs, especially showering, toileting,
is. localised pain. Anti-inflammatory drugs are you see that he looks really unhappy? He's got eating and mobility.
useful for this type of pain. Non-steroidals are a frown on his face, and he can't concentrate
William: Yes, I'm a bit worried about that as
a good example, However , dull, aching pain on anything.
well . Um. why don' t we have a look at the home
which is referred from body organs is best
treated with opioids, or morphine-like drugs.
.
Sarah: Look , Anton He 's not very happy at assessment ? Has the Occupational Therapist
Opioids can be used to modify or change the
.
all is he? team done a home assessment yet?
Anton: No. Andrea: Not yet. I’ve booked a home
transmission of nerve impulses in the dorsal
horn In this way, the opioids pre -empt painful Sharon: And the next little fellow 's feeling assessment with Occupational Therapy on
nerve impulses before they cause discomfort. worse. The pain's very bad now. He 's feeling Monday. I 2th June. That'll give us a better
very bad. This poor guy 's crying and can't even idea about the sort of adaptions which need to
Opioids are also used because it is thought
that they mimic the body’s naLural painkillers, get out of bed because it hurts so much . It's be made for safety and to allow her to be as
called endorphins. Endorphins are naturally the worst pain he's ever felt. Now. Anton , can independent as possible.
found in the brain. you help me by pointing to the face which is Kim: Good. I'm pleased with her progress.
showing how you feel right now ? Does your
Nurse 1 : What about paracetamol ? The weakness on her left side has partially
throat hurt a little bit or a lot ? resolved. Unfortunately, she 's still got a bit
Sonia: Good question. It is sometimes Anton: Er. it hurts a bit. It hurts like the third of trouble with vision loss on that side. I’ve
discounted as just a medication for minor
one. been training her to turn to the left to look for
ailments, but in fact it’s very useful. It’s not only
used as an anti- pyretic drug, to bring down Sharon: Oh, face number three. OK , so it hurts anything she might run into .
high temperatures, but also as a background quite a bit , but it 's not as bad as last night Andrea: Um , Lidia's going to stay with her
drug to opioids. after the operation . All right. I'm going to get daughter. Larissa , until the safety modifications
you some medicine for the pain now. After in the house are finished.
Nurse 2 : Is that why patients are ordered four
you've had the medicine, you might feel like William: That’s good. Tina, what about speech
hourly paracetamol while their pain is being
playing one of our video games. What do you and language therapy ? How's she doing?
managed with an opioid?
think ? Playing games always takes your mind
Sonia: Yes, it is. Using paracetamol with Tina: OK . well my role has been to help Lidia's
off feeling uncomfortable, doesn ' t it ?
opioids reduces the amount of opioids a swallow reflex . I’ve been concentrating on her
Sarah: Thanks, Sharon. I might even be able to swallowing problem and speech difficulties.
patient needs by up to thirty per cent. It's quite
pop out for a coffee while Anton's playing. Remember she had quite a lot of difficulty
important to explain that to them because
they often refuse the paracetamol, thinking Sharon: Sure. OK. Anton . I' ll get you all comfy swallowing when she first came in.
they don't need it. You can see by the different with this warm blanket because being warm
,
Andrea: Yes, her nutritional status was quite
modes of action of analgesics why pain relief helps the pain as well. Er, I'll bring you the poor. There was also the cultural aspect, too
is multimodal . Each drug has a specific job to medicine, and then I’ll get a video game for She wasn ’t used to the food they serve in
do. Pain management is about using several you to play. We 'll let mum go and have a cup of hospital.
coffee, shall we?
drugs together to obtain the best outcome. The
Anton: OK . Do you know the game I want?
.
Tina: No it's very different from her usual
aim of managing pain in this way is to limit the diet , Her daughters helped out with this one
need for breakthrough doses of pain relief. Sharon: I think so. I'll get the one you were They ' ve been bringing in the food which she
playing yesterday. OK ? likes. The kitchen staff have pureed it for her
9.6 Anton: Great! She still has some tongue and lip weakness
Sarah: Hello, Sharon. Look , Anton. It’s Sharon . It's quite hard for her to speak properly I ve
'
She's got that name badge on that you like. 10.1 been practising a lot o# mouth exercises with
Sharon: Hello, Sarah , I think Anton likes the Andrea: Let’s start with Lidia. Lidia 's an .
her and she's certainly improving She's always
stickers I give him after his medicine even -
80 year -old Russian lady who 's been living been a very social person according to her
better, don ' t you? in her own home for 40 years; she's a very daughters, so the ability to communicate is
Anton: Mm . independent woman. You might remember important to her
Sharon: Ah , still hurts to talk, doesn 't it, that her daughters had visited her on a William: Have you referred her for speech and
Anton ? I’m going to get you some medicine to Sunday morning as usual and found her to be language therapy after discharge ?
help your sore throat , but I want you to tell me uncoordinated ; um , she was having trouble Tina: No. I haven' t referred her to a Speech
first how much it hurts. All right? picking up her cup of tea , They noticed that Therapist yet That’s part of the referral to the
she was slurring her speech as well. Lidia said District Nurses Andrea, you've organised that,
Anton: Mm. .
she'd had a 'funny turn’ the night before so haven't you?
unfortunately, by the time they brought her to
Audioscript 107
Andrea: Not yet . I wanted to wait until after Andrea: No, it’s OK. She's already got a feeling. They might laugh even though they’re
the team meeting. I'll ring this afternoon . So, walking frame. She might need a shower chair, very upset or cry when they 're happy. I'll make
can we put Lidia's expected date of discharge though. I think it'd be better to wait until after a note in Mr Bouchard’s notes and pass the
down as Friday, 9 June ? she has a home assessment done before any message on to his Key Worker. She 'll call you
aids are ordered. The home assessment has and talk to you about how you can help your
10.2 been booked for 1 2th June. father at home.
Nadine: District Nursing Service. Nadine Nadine: Er , home assessment 1 2 th June.
Melesky speaking. Gillian: That would be really helpful . I'm afraid
That’s Monday, 12th June, right? I've felt like I don't know what's going on. It’s so
Andrea: Hello , it 's Andrea here from 17 East Andrea: Yes, that 's it. Lidia’s daughter asked overwhelming.
at the Alexandra Hospital . if you could let her know what time the home Simon: I understand. Now. do we have your
Nadine: I'm sorry. What was your name again, assessment 's being done so she can come over contact details on file?
please? to her mothers house. She and her sister are
Gillian: Yes. I gave the nurse my phone number
Andrea: It's Andrea, Andrea Dubois from the a great support. Lidia’s house will need some yesterday. Er. have you got the results of the
Alexandra Hospital. I ' ve got an 80- year-old adaptions and her daughters want some advice
tests dad did yesterday ?
lady I'd like to refer to you for some District on the sort of aids which are available to make
Nursing services. Can I give you the details things easier. Simon: I’m sorry, I'm afraid I can 't talk to
you about your father’s results because of
now ? Nadine: OK. How’s she managed with her
confidentiality. We can only discuss the results
Nadine: Wait a minute, let me get a referral diet?
with you if your father gives us permission.
.
form . OK , here it is. Yes I’m ready, er, it was Andrea: She’s been managing a soft diet for a
Gillian: Oh. yes. I forgot , the privacy laws.
Andrea , wasn' t it? few days now.
Simon: That's right . But I can direct you to the
Andrea: That 's right . Andrea Dubois from the Nadine: Mm , soft diet . Does she need her Discharge Planning Nurse and you can discuss
Alexandra Hospital. meals delivered to her at home ? your concerns with him. His name’s Stephen
Nadine: Thanks, Andrea. Urn, and what’s the Andrea: No. Her daughters are very Wiseman. I'll give you his direct number in case
patient 's name, please ? supportive, and they 'll help her with shopping I can' t put you through.
Andrea: I've got a Lidia Vassily for you. and meal preparation. They know the sort of Gillian: Thanks. I appreciate your help.
Nadine: Oh , OK . Could you please spell that food she likes. No , forty mg not fifty ...
for me? .
Nadine: Sorry I didn't catch that. 10.4
Andrea: Sure. It 's L-I D-I-A. She’s Russian. And .
Andrea: Oh. no, I’m sorry Nadine, someone Katherine: Right, let 's look at left CVA first.
the surname’s spelled V-A-double S -l-L- Y. just asked me a question. I got distracted. Er
I think I've given you all the information you
. Ischaemia causes death of tissue on the left
Nadine: Would you mind speaking a little side of the brain. This causes damage to
slower, please ? I'm having trouble following need . Her discharge summary will be sent to body functions on the right side of the body.
you. you in the next day or so. Is there anything else In the case of a mild left CVA , it causes right
Andrea : Yes, of course. It 's hard over the you need to know ? hemiparesis, or right-sided weakness. More
phone, isn't it? Her family name is V-A- S -S-l-L- Y. .
Nadine: No I think I’ve got everything. Er, serious damage in a loft CVA causes ri ht
thanks for being patient with me. hemiplegia, or right-sided paralysis. ^
Nadine: Vassily, right. Double S , one L. Got it
thanks.
. Andrea: No problem and thanks for your help. Barbara: Of course, ‘hemi ’ means half , doesn't
Andrea: Her address is 24 Spring Lane. it?
Exeter. It 's a bungalow . The spare key’s with 10.3 Katherine: That 's right. Hemiparesis is
.
her daughter Larissa. Her daughter's also her Simon: Good morning, 12 West, Simon
speaking,
weakness on one half of the body: hemiplegia
is paralysis on one half of the body. Now your
next of kin.
Nadine: OK . Do you have Lidia’s home phone Gillian: Urn, it’s Gillian Bonham here. I’m father had a left CVA which is affecting his right
number, please? G lbert Bouchard 's daughter. Am I speaking to side. He's got right hemiparesis at the moment
You will have noticed that his body 's quite weak
.
one of the nurses ?
Andrea: Yes, I've got it here. It 's oh one two six
Simon: Yes, it’s Simon here. I’m a Staff Nurse on that side. The weakness affects the muscles
five, six four four, seven five three. around the mouth as well , and this is why
on this ward.
Nadine: Could you please repeat that ? I didn’ t swallowing’s difficult. The damage caused is
catch the last numbers. .
Gillian: Right, um I'm a little bit worried about
called dysphagia or difficulty swallowing.
my father, er , I don’t want to be a nuisance, ,
Andrea: Yes , sure. Where is it ? Here we are: oh

one two six five, six four four, seven five three. ..
um . Barbara: I noticed that dad’s eating purged
food.
Did you get that ? Simon: Not at all . I' m happy to help you if I
can. Actually, I'm the nurse who's looking after Katherine: Yes , that's right . The other
Nadine: Yes, thanks. Oh one two six five, er, six
four four, seven five Lhree. Is that correct? your father today. consequence of having weak muscles
Gillian: Oh. that 's good. He’s going home soon around the mouth is dysarthria , or difficulty
Andrea: Yes, that's right. Do you want me to
and everything's sorted out as far as that’s articulating words. The muscles of the tongue
give you her daughter 's number, too ?
concerned, but I' ve been worried about his and lips are also weak , so his speech is
Nadine: Yes, please. affected.
moods lately. You never know how he's going
Andrea: Her daughter 's name is Larissa and to be, you know, if he’s going to cry or laugh John: Dad's certainly having trouble with
she’s Lidia’s next of kin, as I said . Her phone at
the wrong time. pronunciation; he just can’ t get the words out
number is oh one two six five, seven eight one
nine nine two.
. Simon: Mm, I can understand why you’re properly.
concerned. It’s quite hard for everyone to Katherine: Yes, the Speech and Language
Nadine: Oh one two six five, seven eight one, handle, isn’t it ? Therapist is also doing some exercises with
nine nine two. Thanks. him. The exercises help with dysarthria.
Gillian: Oh, I'm glad you understand what I
Andrea: Lidia 's GP is Dr Serena Hanif. I'll spell mean. It's quite embarrassing , um , I didn' t Barbara: Dad seems to have problems finding
that for you. It’s H -A-N-l-F want to say anything about it. but it’s been the right word, too. He often comes out with a
.
Nadine: Serena Hanif . Yes OK . H- A - N- l-F. quite difficult. He was never like this before. He word he doesn't mean to say. Why 's that ?
Andrea: Lidia had a stroke three weeks ago. always kept his emotions under control , but Katherine: That's because left CVA often
She’s got moderate left -sided weakness and now he 's like a different person. causes speech and language problems. Some
still has some difficulty swallowing. She needs .
Simon: Yes I know what you mean. It can be patients have aphasia , or an inability to
communicate. Fortunately, your father is able
quite a lot of help with her ADLs, especially quite difficult after a stroke. People who've
bathing and mobility. She's quite unsteady on had a stroke can be quite emotionally labile, to communicate, but he does have dysphasia,
her feet and uses a walking frame. you know. Their moods and emotions go up or difficulty expressing himself. That 's why he
and down and sometimes their emotional says the wrong word for the thought he 's trying
Nadine: Does she have a walking frame or will
I have to order one? responses don' t match what they're really to express.
108 Audioscript
John: It's a real problem , you know. It's really
frustrating him. We don’t know what to do.
.
Deanna: Not very well I'm afraid. She scored a
zero for dressing. She does have clothes which
Sometimes he just starts crying. need minimal help - you know. Velcro wherever
.
Katherine: Mm emotional lability is very possible - but still needs the assistance.
common. It usually shows up as crying at Selena: What about toileting? What did she
inappropriate times, but it can also be laughing score for toileting?
or niggling Oh , it 's very distressing, I know. Deanna : She isn’t able to toilet herself either
John: Oh . OK . Thanks for explaining that. We ' ll so that was a zero, too. She needs quite a lot of
try to be more patient with hirn. He's also SO help getting on and off the toilet or commode.
slow at the moment. Why’s that ? Selena: And transferring?
Katherine: You'll find that his behaviour Deanna: Actually she scored one for that.
pattern has changed. People who have had She uses a small frame to help with mobility
a left CVA tend to have a slow and cautious and transfers quite well From bed to chair, for
behaviour pattern. You'll need to repeat any example. She also scored one for feeding. She’s
instructions you give your father a few times able to use modified utensils to eat. As she still
before he'll understand them. That 's also eats a soft diet, she manages quite well.
because he has memory loss: his short - term Selena: So that just leaves continence.
memory 's been affected.
Deanna: Ernesta is incontinent of urine. She
.
Barbara: Yes we've noticed that. He can’t uses pads during the day and night so she
remember something from five minutes ago
but remembers our family holidays when John
scores zero for continence .
and I were children Selena: Thanks for that information. We
have a good programme here to encourage
Katherine: Oh , and another important thing: independence, so we'll try to work on those
there 's absolutely no hearing loss during a areas where Ernesta needs most help.
stroke.
.
Barbara: Oh dear I' ve been shouting a bit at
dad thinking he couldn 't hear properly. I'll stop
doing that. He must’ve hated it.
Katherine: Don 't worry, it's a common mistake.
10.5
Selena : The Pines care home.
.
Deanna : Hello , yes it’s Deanna Giles here from
4B at Alexandra Hospital. I have a patient
transfer for you .
Selena: Oh , yes. I' ve been expecting a call from
you. Can you fill me in about her, please ?
Deanna: Sure. Her name is Ernesta Bortoli.
That's Ernesta E - R -N - E -S- T-A and her surname
is Bortoli That 's spellod B-O - R - TO- LI. She’S
an 87 -year - old who had a left CVA six weeks
ago. She 's been here with us in Rehab for the
past month and has been doing very well.
Unfortunately, she just can ' t manage in her own
home any more.
Selena: Well , we’ll try to settle her in here. I'll
have a lot of assessments to do on admission,
but it’s always useful to get an idea of how
she’s been managing her ADLs in Rehab.
Deanna: Sure. She's improved a lot over the
last week . I 've just done a Katz Index to assess
her level of independence with ADLs. I'll go
through it with you now if you like.
Selena: Thanks, it gives us a better idea of her
needs. Just a minute. I'll just get one of our
.
charts so I can fill it as you tell me. Right I’ve
got it. What did she score?
Deanna: Well, overall her score was two out
.
of six which puts her at moderate to high
dependency.
.
Selena: OK I'll just put that score at the
bottom of the chart before we start ,
.
Deanna: OK bathing first. She scored a zero
for bathing, as she needs assistance getting
into the shower and can 't manage to wash
herself. You'll need to shower her on a shower
chair with assistance. She has quite a lot of
residual hemiparesis from the stroke.
Selena : Right, that would affect her ability to
dress herself, too, wouldn 't it? How does she
manage ?
Audioscript 109
vernai
KEY
HR Unit 1 b 2 Pat ent details and treatment which are
1 I see already noted cn tne printed handover
la
2 mm hm
Suggested answers
1 The nurse is taking down patient details
3
4
'
nodding your head
sheet are not repeated - this is to save
time, as the handover usually only lasts
be'ore the patient goes to the ward Some eye contact 2D 30 minutes
admissions are done after the patient has c 3 Inaccurate handing over of information
arrived on the ward, in which case it is the Shona smiles, laughs. nods and leans towards can lead to medication errors , incorrect
ward staff who admit the patient. Mrs Chad She also uses mm preparat on for tests, and missing
2 The kind of information collected would be appointments with other healthcare
personal aetaifs such as name and contact 3a professionals, for example X ray
1 The card ac cycle includes all events which
.
number of next of in, past medical and
*
surgica history, and details of allergies
3 Because it is important to alert staff to
occur from the oeginning of one heartbeat
to the beginning of the next heartbeat , for
b
1 Uncontrolled hypertension
example systole and diastole. 2 She had a heart attack Imyocardial
allergies and any problems in the patient's
2 The atria and ventricles contract and then infarction) in June.
past medical or surgical histones
the whole heart relaxes. c
b 3 Shortness of breath , as not enough b ood is I T
1 Yes. with the help of a suck. oxygenated by the lungs. 2 T
2 No. she hasn 't 4 The nurse in the Caraiac Unit Is sometimes - BP 210/ 105
3 She is being admitted to the Cardiac Unit .
c
-
rcqu red to teach patients about the
cardiac cycle in order to explain some
3 F
4 F
5 T
- P was 100
2 Good morning Shcna . of the cardiac tests or procedures which
patients have before heart surgery
d
3 How are you today7 2 m 3 b 4 f 5 1 6 c
.
4 Not too bad thank you. b 1 ) 8 h 9 e 10 n 11 d
5 I' d like to ask you a few questions, if it 's all the atria - receive blood 12 a 13 k 14 i
right with you7 tne ventricles pump blood
6 Yes of course That 's fine the pulmonary artery carries de oxygenated e
blood to the lungs 2 Ml
d 3 SHO
1 She has high blood pressure and is in for the valves open to allow blood to flow
4 BP
some tests between the chambers and then close to
prevent backflow of blood 5 fcCG
2 She had a mild heart attack . 6 CTN
3 No. she doesn t think she has any allergies. the pumonary vein - carries oxygenated blood
7 O,
4 Yes, her son. Jeremy Chad 'rom the lungs to tne left atrium
the aorta - brrngs oxygenated blood to all f
e parts of the body 2 10 pm
2 e 3 d 4 b 5 f 6 a 3 5HO
7 c 4a
They are talking about lifestyle changes after a 4 Oxygen
9 diagnos.s of hypertension, which are needed to 5 two hundrec and twenty over one hundred
Suggested answers manage his blood pressure at home. 6 pulse
1 You would assist the patient to sit down 7 one twenty
ano make sure s /he was comfortable before b 8 five past ten
starting with the admission The patient 's 2 g 3 c 4 d 5 b 6 f 9 SHO
full name, including title, is used as a mark 7 a 10 CCG
of respect You may also use more formal c I sublingual
language, for example FVou/ d you mmd 1 same level 6a
if ... , Could you pleose 2 positive Suggested answers
2 With children, the nurse wou d greet the 3 judgemental 3 Nurs ng and other healthcare professionals
child by his/her first name and use his/her 4 rapport have access to these charts, which are
own first name in return The language
Id 2 a often keot at the end of the patient ’s bed
usee would be informal, lor example Con 3 b 4 c
in an opaque plastic foider for privacy.
you .
pieose You would put the child at d However, the charts are easily accessed by
ease and anticipate any anxiety about the Susanna sits at the same level as the patient , the patient or friends and relatives of the
hospital admission. - nods and uses humour to establish a raoport patient
3 It is important to empathise with the She also uses Mm . yeoh 4 The nurse who is looking after the patient
oat ent and apologise *or the wait
5a is responsible for completing the chart A
Reassure the patient that you will adm t
Suggested answers st idem nurse nay complete the chart if
him her as quickly as possible
1 Handovers should alert nurses to the checked and countersigned by a qualified
2a nurse
Suggested answer
presence of IV therapy, drains, wounds, etc
Medication rev ews and test results should
.
I Active listening strategies are used to*
b
be given Staff should be iuformec of any 1 She wiil be in hospital for three days.
put the other person at ease, show
tests or procedures wb ch will occur during 2 Dr Yielding came lo see her because her BP
interest in what is being said , and confirm the next shift Handovers should only give hao increased and she was complaining of
understanding of what has seen said information about the changes in condition
These mt ude gestures, body positior - for chest pain ,
or treatment which have occurred during 3 Jenny took her ooservations before giving
example, leaning towards the speaker
- node ng. making ‘listening noises',
the relevant shift the handover.
respecting personal space and maintaining
comfortable eye contact
110 Answer key

c 2b c
Ttme P BP 2 at the same level 1 a H b A
06.00 76 1 7 5 90 3 That's right
10 00 112 '
210/ 150 4 I'm going to teach you how to , ,
2 a
3 a
A
H
b H
b A
14.00 97 195 / 90 5 understood 4 a A b H
15.00 86 180/ 85 6 firstly , secondly; fingers
7 Demonstrate
d
d 1 becomes inflamed
8 Repeat
1 One hundred ana ten over / on seventy 2 conducted
is
2 One hundred and fifty over /on ninety c 3 is exchanged
5 One hundred and forty- two over on Eleanor states the purpose of the A is narrowed
ninety-nine ' communication I' m going to show you how to 5 tighten
A Eighty - six over / on forty use a peak flow meter today . 6 to breathe
She smiles and nods at Mrs Drake
e The verbs in 1 - A are in the passive The
She g ves the instructions ir steps I 'll go
Suggested answers passive lobe 4 past participle is often used
through it with you step-by - step
She encourages her Yes. you will! Don ’t worry , .
to describe a process for example is
shoot up to iettfe go down it’ll become o habit .

. .
conducted. .. is exchanged. .. is narrowed,
She uses an appropriate level of language
... is produced . You can also use fo become
peak remain the same }oll + past participle to describe a process, for
(maximum to be constant piummet She demonstrates I' ll just show you how to use
example becomes swollen
result ) to be steady (succen decrease) the peak flow meter
She gives her the opportunity to ask questions 5b
H Unit 2 [ Do you have any questions? }. 2 level
3 simple
la 3a
A diagrams
I The peak flow meter is used to measure 2 Bronchodilators [medication that makes
5 decision- making
how fast a person can blow out air after the airway wider): inhalers and nebulisers
6 encouragement
taking a big breath in to make breathing easier [ a spacer is
7 appeal
attached to make it easier for a child to
b 8 cheerful
use an inhaler); dust reduction in the home
1 Mrs Drake feels much better ; her chest 9 explain
(vacuuming every day)
feels less tight and she is breathing more c
easily b Tim s ts at the same level as Sus .e Can I come
2 So that she can keep an eye on her astnma 1 Put in the meaication
and sit here with you for a while7
when she goes home. 2 Connect to the oxygen
He uses simple, clear sentences and checks for
3 At the same tine each day. 3 Put on the mask
understanding Can you see that there is less
A To take the oeak flew readings at the same A Turn on the oxygen
room for air to go through7
time every day, write the result on her Daily 5 Breathe in the mist
He uses a diagram to illustrate his talk Hove a
Record Chart , and bring this to the Asthma c look on the first page, and you ’ ll see a diagram
Clinic 1 c 2 e 3 a A d 5 b of what we coll your respiratory system.
c d -
He involves Susie in decision making Does that
1 Would you mine sound like a good idea7
Melanie states the purpose of the
2 I’d like you He encourages Susie Good on uouf I thought
communication I 'd just like to show you how lo
5 could you you ' d find it interesting
use this nebuhser
He uses a cheerful tone of voice
d She sits at the same level as Mr Dwyer so is
2 Now stand up. Take a deep breath and try
,
non - threatening Til bring a chair up so I can 6a
to fill your lungs as much as you can. have a chat with you . 2 d 3 c A f 5 g 6 b
3 Next , blow as hard and as fast as you can She smiles and nods at mm; she gives the 7 a
with one breath instructions in steps HI go through ail the
b
A Make a note of the final position of the steps with you
1 inspiration
marker She encourages Mr Dwyer It 's not too difficult
I 'm sure you' ll catch on quickly
2 inspiratory rate
5 After that I want you to blow into the peak 3 respirations
flow meter two more times She gives Mr Dwyer the opportunity to ask
A respirator v rate
6 Tnc last thing to remember is to record tnc questions Any questions7
•
5 expiration
highest of the three readings on your Daily 4a 6 expiratory rate
Record Chart 2 oral cavity
d
f 3 voice box I larynx
1 Mr Frank 's family are staying with him
In most of the instructions, the verb is an A bronchus
because he is dying .
infinitive without to blow. move, make take 5 alveoli
2 Judy is managing the pain using a PCA with
This is the HOST common and direct way o‘ 7 epiglottis morphine.
Q windpipe / trachea
giving instructions and is appropriate after 3 The oxygen is being delivered by nasal
9 pleural membrane
you have softened your request , for example cannulae (also called nasal prongs).
Would you mind ... I d like you to ... Could you 10 intercostal space
A The tachypnoea was caused by a lung
. There are also useful phrases like / wont b infection
.
you to and The last thing to remember / s 1 The inner muscle of the asthmatic airway s
.
. both of which are followed by an infinitive inflamed so it is hard for air to go through ^1 Poorly managed asthma
with to 2 An asthmatic makes a wheezing noise when 2 Antibiotics
trying to breathe during an asthma attack
3 She is having a chest X - ray and the
they may also clutch their neck and look Respiratory Team is visiting
distressed 4 Peak flow readings
b
2 f 3 a 4 c 5 b 6 d
Answer key 111

d b 12 fluid
1 Hourly 1 What do you think I should do with this 13 optimal
2 Three litres a minute ulcer ? 14 chronic
3 Because Mrs Castle became breathless 2 What do you suggest we use7 What would 15 Reassess
4 30 minutes
e
RR at 06 00 was 18 breaths not 16
3 .
you recommend that we change to?
Wou o you mmd giving me some advice on
his wound care management ?
16 graft
17 advancec
4 What would you recommend that we 5a

Pam score at 14 00 was 7 / 10 not 6/ 10 2 An estimated 15 20 c of dog bite wounds
RR at 14.00 was 26 not 22
5
change to7 What do you suggest we use?
Do you think it’s a good idea to try that
*
become infected Although rare, if infections
RTW on three litres o oxygen not four at
-
aren’t treated they may ieac to septic
instead of the dressing they 're using now
14 00
*
RR at 15.00 was 20 not 18
f
3a
I
Suggested answers
in
problem
.
arthritis or generalised sepsis Dog bites
areas where rab es is present is also a
1 b 2 d 3 e a Looks infected as it has pus in the wound It 3 Complications can be avoided by seeking
4 c 5 a
ooks rec and sore medical treatment as soon as oossible and
9 b LOOKS black and uneven around the edges keeping up to date with tetanus protection.
1 apnoea with yellowish material in the middle
2 bradypnoea c Looks like it has dead tissue around the b
3 eupnoea edges It looks blackened and not healed 1 Puncture wounds
4 tachypnoea d Looks red and dry 2 Flushed with normal sai ne. not sutured,
5 dyspnoea dressed daily
b
h 2 a 3 b c
.
1 No the p is not a s lent letter in ail words. 7 f 8 c
4 g 5 d 6 e 1 c 2 a 3 d 4 b
2 Apnoeo and eupncea don’t have a silent p
c d
i 1 necrosis 2 He was treated in A&E and discharged
1 AE air entry; FBC full blood court 2 eschar home
.
2 No she is afebrile 3 desiccation 3 The wound became in 4ected and he has
3 Fast she has tachypnoea 4 inflammation returned to hospital .
4 The day the report was written 7 debr dement 4The wound was reassessed yesterday.
5 Yes. she nas to start takirg it again 8 cellulitis 5 Gary was started on IV antibiotics to clear
up the infection in the wound.
e 6 Tne wound was surgically dcbriced this
Unit 3 1 eschar (photo c) morning
la 2 ce<ljlitis. desiccation (photo d] 7 Gary returned to the ward with an
Suggested answer 3 inflammation; swab (photo a) antimicrobial dressing which will be
5 Possible compilations with wound healing 4 slough, debridement (photo b) re dressed tomorrow
nclude infection, delayed healing, pain, 8 He is in for a review by the Vascular Team
lack of mobility and amputation
Suggested answers or Monday.
b 1 The location of the ulcers would make it e
1 She’s removing the dressing on a leg wound difficult to apply a wound dressing ana 2 d 3 1 4 k 5 a 6 j
2 To make sure there is no cross-infection mooilisat on would be a problem. 7 f 8 1 9 c 10 h II b
from the bacteria on her hanos 2 Diabetics should never go barefoot as nerve 12 e
c damage decreases awareness of sensations
in the foot and so injury in the form of skin f
1 For aov.ee on the management of Mr 1 granulated
Jones’ wound cracks often goes unnoticed These can lead
to ulcers. 2 sloughy
2 Venous ulcer 3 macerated
5 Twc weeks 3 A consequence of diabetic ulcers can
d
-
be a non healing wound and ultimately 4 inflamed
5 serous
amputation of the foot.
2 He developed a venous uicer on his right 6 haenoserous
4b 7 purulent
ankle after he tripped on some stairs .
high bacterial load necrotic tissue exudate 8 odour
3 His local doctor had a look at it and asked ,
the District Nurse to come and dress the c 10 antimicrobial

wound at hcrr e .
4 Two weeks ago he was admitted to
2 g
7 d
3 h 4 e 5 f 6 b
11 hydrating
12 intact wound
8 a
this ward to have an assessment of his i
circulation and to monitor his wound e
2 base 1 N/ A
management. 2 tds
5 He had a Doppler test done last week 3 inflammation
4 balance 3 bd
6 We sent a wound swab off. and we just gor 4 L
the results yesteraay 5 necrosis
6 load 5 IV
7 He’s started on some IV antibiotics 6 amt
7 exudate
f 8 dryness
2 g
J
3 4
7 e
b a 5 c 6 d f L calf, sloughy, nfectea . daily. IV inflamed
small amt purulent yes (odor present),
.
2 Debridement ,
9 5 surgical surgical antimicrobial, ooen wound, for review

1 Because t was not healing at home 4 well vascuiarised by Vascular Team on Mon, wouno intact next -
2 A VAC dressing 5 infection dressing in two days
3 To help the wound heal faster 6 antibiotic
2a 7 Reduced Unit 4
1 c 8 imbalance
2 a 3 e 4 b 5 d la
9 Excessive 3 The nurse may be discussing aspects of the
10 Desiccation patient's
care with her
11 dressings
112 Answer key
b 11 90% 2b
1 To have a Personal Care Plan set up 12 oral 1 c 2 b 3 d 4 e 5 a
2 Her local doctor 13 inhaiersypumps
3 She couldn t control her blood sugar level
'
14 pumps/inhalers c
at home. 1 Repeat
e 2 Paraphrase
c Option 1 c 3 intonation
1 F - the hospital referred her Option 2 a 4 clarify
2 F - she doesn ' t have one yet Option 3: b
5 T 3a
f 2You need to clean the area around the
d 2 catheter urethra from front to back with these
1 How often 3 bolus disposable wipes
2 How many times 4 large swings 3 Don 't touch inside the container when you
3
4
How frequently
Do you ever
5 vial
6 disposable
ta e the lid off
* .
4 Try to catch the middle part of the urine
5 Do you always 7 Varying stream
8 mixed 5 Tighten tne lid before you give me the
2a 9 accurate doses
Oh dear, thats a shame ; Mm Yes ... . Mm, I specimen container, please.
10 convenient
see. That s good, Ot* . that 's a pity. Mm: Oh . 11 cartridge b
that ’s not so good la 2 c 3 b 4 d
12 Prefilled
3a 13 convenient 4a
1 l ifestyle charges include stopping smoking 14 end Suggested answers
exercising more, losing weight , eating a 6a 2 Features of a good communication system
healthy die: and cutting down alcohol
intake
1 Times of BSL testing and results, times and .
induce: records time of pag ng, easy to use
results of urinalysis, and times of hypos alerts staff member when page has been
c 2 Five times a day received,
3 Her urine ( testec for glucose and ketones} 3 Mobile phones are often used in place of
2
3
4
need to
Try to
should
4 She is given lemonade
5 She checks her BSL again
-
pagers and email is also sed Technology
is also changing the way nurses document
patient information: for example, care
5 good idea b
6 must plans are computerised rather than hand
1 T written , cutting down time and limiting
7 important to
8 might like to
2 F - she is 85 errors caused by illegible hancwnting
3 T Some hospital pharmacies use a bedside
e 4 T comDJtensec system to order and supply
2 a 3 d 4 c 5 b 6 f 5 T
-
patient medication, reducing tne amount of
7 e 6 F - should be less than 10 mmols 1 Vi time spent visiting hosp tal pharmacies to
hours after meals pick up scripts.
4a 7 T
1 To produce digestive enzymes and secrete b
them into the small intestine via the
-
8 F it went up to 15
1F - she is calling to tell the doctor the
9 T
pancreatic duct . 10 T patient has frequency and burning when
2 To release hormones Into the bloodstream; she passes urine
the beta cells of the islet cells in the c 2 T
pancreas secrete the hormore insulin into .
Hypo at 09.00 not 03.00. BSL 4.1 after 3 F - the doctor will come and write up some
the bloodstream. lemonaae; 7.1 at 16 30 yesterday; 8.G at antibiotics in hfteen minutes
3 It lowers them. 02.00 today. 5.2 at 11.30 today. 4.8 at 21.30 4 T
4 Clue agon today; no hypo today.
c
5a d 2 remind me
2 e 3 d 4 j 5 b 6 h Suggested answer 3 in for
7 f 8 a 9 g 10 i Her diabetes is poorly managed 4 complaining of
b 5 febrile
1 pancreas mm Unit 5 6 up a bit
2 diabetes 7 malaise
la
5 diabetic 8 MSU
Suggested answers
4 hypoglycaemia
9 write up
1 Biood. urine and other specimens are
5 hypoglycaemic agent 10 Pathology Form
checked ‘or things like electrolyte levels,
6 glucosuria presence of infective agents, sensitivity 5b
/ ketones to antibiotics and presence of diagnostic 1 To filter the blood and remove waste
8 diabetic keloacidosis agents for particular diseases, for example products, which are secreted in urine
9 insulin specific enzymes. 2 Nephrons
10 blood sugar level 2 To monitor the progress of their patients 3 The renal medulla
to check for toxicity of a drug before 4 The bladder
c
2 regulates administration. to monitor infection and 5 The urethra
dec de on changing patient precaution code
3 glucose 6a
(standard precaution to special precaution)
4 fat/liver 2 i 3 g 4 b 5 h 6 a
5 liver /fat b 7 d 8 f 9 c 10 k 11 j
6 fuel 1 It hurts when she passes urine and she 12 m 13 I
7 beta needs to pass urine frequently.
8 normalise 2 UTI
9 children 3 Culture and Sensitivity test (C & S)
10 injections 4 A midstream urine specimen ( MSU)
Answer key 113

b 9a c
1 urinalysis Suggested answers 1 c 2 aid 3 a/d 4 0
2 urme 2 Pathology Reports contain information
3 urinal about the analysis o? specimens, presence d
5 renal of nfective agents, celts which are visible Have you got a minute7 - b
7 proteinuria under microscopy, and the sensitivity of the Are you free at the moment? - a
8 haematuria organisms to various antibiotics Are you busy at the moment or can you do a
9 specimen 3 They are consulted before giving drug check with me7 - o
10 oedema medications; to check on results of Would you mind checking this morphine with
11 anuria specimens which have been tested ; and me, please ? - c
12 nephrons to check blood results, for example for e
13 oliguria anaemia. 1 eyeballs
d 5 The nurse will phone the doctor if an 2 snowed
1 T abnormal result comes in. particularly if it 3 flat out
2 F - it’s the first stage Is serious. 4 run off
3 T b All of the expressions mean very busy
4 F - it requires dialysis or transplant 1 Urine microbiology
5 F - in early stages there are often no 2 Microscopy 2a
symptoms 3 M5 U 1 Pethidine ) 00mg IM
4 18 45 on 6 March 2 Because Anna is carrying the CD keys so
e she can umock the drug cupboard
2 nephrons 5 07 18 on 7 March
6 Increased leucocytes, increased 3 Count how many ampoules are in the
3 toxic
erythrocytes and tne presence of bacteria cupboard and confirm the number ieft
4 renal failure
7 A bacterium when one is removed
5 urine 4 They both have to sign the drug book
6 oedema 8 Antibiotics
9 That t showed a possible UTI 5 The dose ( lOOmg) and the expiry date
7 lethargic (Apr I. 2010)
8 renal transplant c
2 sensitive b
7a
3 bacteria 2 Check the time the last injection was given
1 An ordinary sample
4 Microbes to the patient
2 Proteinuria , haematuria. pH value
5 antimicrobial 3 Get an ampoule from the locked cupboard
b 6 microbiology 4 Check the number of ampoules left in the
Tne words just and only are missing. 7 erythrocytes cupboard
1 I d just like you tc do it now. if that s all 8 pathology 5 Sign and witness the drug book
right. 9 Microscopy 6 Check the expiry date of the drug in the
2 I just need an ordinary sample of urine. 10 culture ampoule
3 It only takes a few minutes to get a 7 Draw up the correct amount of the drug in
reading Share your knowledge a syringe
4 I ’m checking for proteinuria ; that just Suggested answers 8 Check the amount of drug drawn up in the
means protein in the urine To determine whether it is viral (not syringe
5 Just ring when you want me to collect it treatable with antibiotics), bacterial
{ treatable with antibiotics) or fungal d
d ( treatable with anti-fungals) Also to identify 2 f 3 d 4 a 5 c 6 e
The use of just and only softens the tone of the the appropriate antibiotic which the 3
sentences. infection is sensitive to 2 f 3 a 4 b 5 e 6 d
8a 2 More arb more people are becoming
resistant to antibiotics , so larger doses of Share your knowledge
Suggested answers
antibiotics are reeded to fight the infection Suggested answers
2 Patients who are immoole because of
if it recurs. 1 Team nursing is a type of nursing model
surgery . su fering *rom a spinal cord injury.
etc .
' 3 Methicil m Resistant Staphylococcus which makes use of the different skill levels
Aureus. a;so called golden staph , may of the team and allows for the different
3 Infection and tissue damage
cause cellulitis, wound infections and other scopes of practice between RIMs and other
4 New developments in seif -catheterisation
serious infections levess of nursing , for example Ass stant
include catheters with a low- friction outer
4 It is a senous problem in almost all Nurses. Enrolled Nurses anc Healthcare
coating. They are disposable, so more
expensive . Out carry fewer infections risks hospitals in the world Assistants ( HCAs) Team nursing was
introduced in the 1950s to cope with post
b Wm Unit 6 wa staff shortages It regained popularity
'
Not being ab e to pass urine (urinary m the 1990s as a way of dealing with staff
retention) la shortages
2 Insert an indwelling catheter Suggested answer 2 Working as a team , each member
3 A drainage bag 4 Controlled drugs are regulated so strictly encouraged to make suggestions, can lead
because they are highly addictive and to fewer staff absences as the ê is a sharec
c
illegal without a prescription . They must be workload .
1 pass urine
controlled to avoid street use. 3 Often viewed as tosh allocation nursing
2 in situ
3 contamination b where a task - for example, taking all
4 transparent 1 She needs another nurse tc check the observations - is allocated to one nurse:
morphine because it is a controlled drug this can lead to boredom , potential
d problems with accountability, and become
2 f
2 An injection of morphine
3 a 4 c 5 b 6 e divisive with some nurses taking on the
3 He has to prepare a patient or the
Operating Theatre.
' heavier workload wh le others write the
4 Yes She Is clearing the dressing trolley, and Patient Record
then she rs free
114 Answer key

4a
Answers
6a
1 Those which decrease the elimination
» Unit 7
1
1 Medications which regulate the heartbeat ; of the drug from the body, for example la
anticoagulant medication such as warfarin erythromycin and cycosporine. Warfarin 2 When dehydrated, after surgery to ,
insulin; and IV antibiotics These may and niacin are also contraindicated administer IV medications
have serious side effects which may occur 2 The build up of the drug could cause b
rapidly, for example ncreased bleeding or a muscle damage. 1 An IV pump, a new bag of IV fluid hanging
drop in blood sugar level 3 Grapefruit juice and 'elated fruit such as up ready to be started and a smal bag of
2 To check on the blood level of the Seville oranges fluid going through an IV line which is aiso
drug, especially if the dose is adjusted
b ready to be connected.
accordingly
1 advisee not to 2 Reviewing IV fluids, discussmg fluid intake
b 2 should must net be taken; increasing the and output
1 He wants her to check a medication risk
'
c
{ warfarin) with him 3 should be 1 T
2 Chris Multer in bed I 4 must not take 2 F - Paula is looking after Mrs Boland while
3 An anticoagulant medication 5 should,'must not be taken; increases the Mrs Boland s nurse is off the ward
'
4 The INR toxic effects 3 F - they are quite low

5 Josh srgns and Susanna countersigns 6 precaution to take 4 F - she is to start 1 L Normal Saline with
c c KCI 40 milhmols
2 Crosscheck chan and patient information 1 Her weekly rounds in the ward 5 T
5 Check the medication label 2 Mr Albiston’s chart 6 F - the cannula is going to be removed
4 Crosscheck route 5 She noticed that Mr Albiston had been d
5 Crosscheck time of administration ordered a multi B vitamin, which is 2 a 3 a 4 a 5 a 6 b
6 Check the INR result contraindicated with atorvastatin 7 a
7 Crosscheck dose on Medication Chart 4 Vitamin B 3
8 Take out medication 5 Helen will notify the doctor to cancel the e
9 Sign Medication Chart order . 1 Could you take down Mrs Bo and s IV when
it's finished, please9
'
10 Countersign Med cation Cnart
d 2 Leave it ( the cannula) for another day ...
Share your knowledge 1 need to be 3 Could you start her on a litre of Normal
Suggested answer 2 I’m a bit concerned Saline with 40 millimols cf KCI?
3 Some units have introduced dedicated 3 shouldn't be 4 Can you run it over eight hours, please?
Medication Nurses who are responsible 4 shouldn't take 5 Can you take out his cannula before he
for handing out a I medications. The pros 5 not to goes home, please?
are that they get less distracted by other
tasks, can concentrate better, have less 7a 2a
time pressure and are not interrupted Suggested answers C - Light dressing
while completing their round The cons 1 It is a Prescription Cha't . B - Take down IV when thr
are that some nurses feel uncomfortable 3 It shows the name of the medication, the D - Run IV 8C
having another nurse dispense medication dose, the number of times the nedicatior is D - IV ABs
to ‘ the r ‘ patients, as they feel they aren 't to be given, the prescribing doctor's details B - Leave cannula
accountable for total patient care. and the date of the drug order D - K levels
4 The pharmacist, the doctor and the nurse C - Home this pm
5a are responsible for the chart D - Put up IL N/S with KCI 40 mmols
Suggested answers 5 It is updated each time a new medication is C - Cannula out /
1 Because nurses arc well placed to spend ordered or when a drug must be reordered
time answering questions and addressing b
oat ent concerns.
b Because these tasks have already been done
2 An incorrect dose may be taken, the wrong 2 f 3 d 4 g 5 e 6 i
7 a 8 c 9 j 10 b c
drug may be taken, and precautions may
2 He said tc leave the IV cannula in for
not be followed. c another day just in case she needs more
3 Interactions special precautions, po. mg mane fluids
contraindications, and storage of the drug 3 He asked if you could put up a bag of
e
b 1 27 April Normal Saline with 40 mmols of KCI
—
1 F it lowers cholesterol levels 2 08.00 4 He wants it to run over eight hours
5 He said that Mr Claussens IV cannula cou d
2 T 3 Yes. he has had three doses
3 F - it 's absorbed in the stomach 3nd small 4 A multi B vitamin be taken out
intestine 5 No Share your knowledge
4 T 6 You would not give Mr Albiston a multi B Suggested answers
5 F - it s better to take it in the morning
'
vitamin at the same time as atorvastatin 4 Advantages of preloadcd IV infusions
c because cf the drug inter action decreased bacterial contamination,
2 passes into 8b accurate dose of additive is ensured,
3 leads to 1 The right drug less chance of medication error, more
4 mixes with 2 The right Datient convenient, decreasec nurse t me in
5 goes into 3 The right route preparing IV solutions with additives
6 via 4 The right dose Disadvantages: cost, possibility of
7 metabolised 5 The right time mistaking dose (IV bags are ioaaea with
8 causes .
22 nmols KCI 30 mmols KCi or 40 mmols
9 inhibiting
c KCI. with no colour coding to alert of
1 c 2 e 3 d 4 a 5 b different dose)
10 released into
Answer key 115

3a Share your knowledge c
1 To see that the IV cannula s in order before Suggested answers 1 Miss Stavel’s Fluid Balance Chari
she puts up another infusion I Other ways messages can be passed on 2 ft isn't accurate
2 Warmth, redness, tenderness include writing the message on the ward 3 Her daily weight
3 Six
4 It was in ar inconvenient spot , which made
whiteboard or message board, or send ng
an SMS if nurses use mobile phenes to
4 No intake record 10 am 5 pm -
04.00 Wet bed+
the IV positional -
that is the IV stopped send and receive messages. 05.00 Vomit Lge amt
dr pping when Mrs Boxmeer moved her 3 Some problems that occur when messages 08.00 Wet bed-M
arm have to be passed on include the ward or Hasn't passed urine sir-ce lunchtime
5 The IV cannula is removed unit not having a prominent place to disp ay 13 00 (U/O) UTT
messages so the messages are no: noted, I 7.00 Amount •? cup; Vomit 5ml amt
b
staft. tak »ng messages without making a '
2 f 3 i 4 e 5 g 6 b d
7 h written note and then forgetting to pass
8 d 9 a 2 recorded ; inaccurately
them on . messages not being understood
c correctly and not being passec or because 3 measure; properly
1 nosocomial of embarrassment , and messages not being 4 problem; record
2 phlebitis passed on in a timely manner and being 5 accuracy
3 infiltration forgotten 6 point; mistakes
4 Staph e
5 IV giving set 5a
1 The chart is used to order IV infusions 1 It 's impossible to know what size cup!
6 erythema
2 It really doesn’t look as though it was
/ aseptic technique b explaned to her at all.
8 positional 1 She ' s going on a break 3 .. they haven t been able to measure it
’
e 2 Because she was receiving IV antibiotics properly

2 put; in when she was first admitted
3 put in 3 Normal Saline
4 To check out the next IV infusion as the
KB Unit 8
4
take out
5 leave , out current infusion has just finished la
6 put in 5 Miss Hadfield’s details, the Lime the current Suggested answers
7 put; in litre staled, the time it finished the 2 Pre- op checking procedures ensure that all
8 put; in amount of fluid that went through , tne next information s correct , for example: correct
9 take, out order (date, route (IVI), name of solution] identity of the patient , consent form s gned.
10 take ; out 6 The name of the solution and the expiry
date
correct preparation made for the operation
etc
.
11 kept In
/ The infusion rate 3 Incorrect checking could lead to the wrong
4a 8 Both nurses patient being taken to the Operating
Suggested answers
1 Nurses would use the telephone to report
9 The exoiry date Theatre, the wrong pre -med being given
Theatre staff not being alerted to allergies,
.
test results, report a change in a patient 's c
and a patient who has not fasted pre-
condition, request SHO to review a patient 2 8
operatively vomiting during surgery
request medication order, book tests book 3 03 00
,
porters, etc 4 11.00 b

2 Nurses might receive the following types of 5 1000 ml 1 Mrs Clarke has to wash twice with
information by phone: information relating 6 30th antiseptic wash -
once the evening before
.
to patient care e.g. test results phone
,
7
8
5%
30th
the operation and once on the morning of
the operation. She also has to remove her
orders for medication fin some countries),
messages for patients from family or friends 9 5% nail polish.
4 You can avoid misunderstandings when 10 16 th 2 Because it’s a choking risk with anaesthesia
taking phone messages by asking the 11 2010 3 To prevent DVTs
caller to repeat any information which 12 11.00
13 10
c
you have not understood immediately, 2 I'll
asking the caller to speax slowly if you 14 1000 ml
3 you’ll
can 't understand, always noting down the 15 100 ml
4 Will
message and asking about words you oon't 6a 5 I m going to
'
understand, and always asking for unusual 2 It records fluid intake and output in order 6 won't ; will
words or names to be spelt out . to assess fluid status. 7 I'll; You'll
b 3 It is the responsibility of each nurse to fill
out the chart for his / her shift
2a
Dr Gonzalez; resite cannula Mrs Szubansky , Suggested answers
Michael to call re when cannula needs rcsite. b 2 When dealing with children and non -native
.
due time of next ABs bleep Dr G on 645 2 UTT speakers of English, it is a good idea to
c 3 BO show them any pieces of equipment or
.
2 Sorry I didn t catch the patient ' s name. 4 C/F show pictures of what to expert after an
Couid you spell it for me. please ? 5 U/O operation .
3 so you need to talk to Mrs Szubansxy s 6 H .O 3 Pre-op patient education has been shown
nurse about resiting a cannula ? 7 BNO to improve patient compliance with any
4 Would you mind slowing down a bit? I'm 8 Sml amt post -op activities, for example po$ t op
*
afraid I've missed some of tne message 9 Wet bed + exercises It also decreases patient anxiety
5 OK . Let me just read that message back to 10 OJ and lessens the experience of pain . Benefits
you. 11 to KVO to the healthcare system include reduced
6 I'll make sure I pass on your message to 12 Asp days in hospital and less likelihood of return
Michae!. He s the nurse looking after Mrs 13 Mod amt to hospital with avoidable complications.
Szubansky today. b
7 Can I get a contact number so Michael can
Id 2 e 3 b 4 c 5 a
return your cali?
116 Answer key

3a c d
I Before surgery it is important to explain 1 That she might overdose 2 I’m just going to go through this Checklist
about IVs. IDCs. drains arc dressings wh> ch 2 Alva explains the ‘ lock out ’ feature, which agan.
the patient will return with. Post -operat' ve prevents patients over -using the PCA 3 I know you’ve already answered many of
activities for example, deep breathing 3 The nurses will check her obs and her pain these questions, but we like to double -check
and coughing - may need to be explained. level second hourly (required during the use everything.
Preventative measures sjch as anti -embolic of a PCA) . A Can you tell me you' full name, please?
stockings and heparin injections shou d also L Emma will use her tri ball every hour whilst 5 I II have a quick look at your identification
be explainec she is awake. bracelets if I may?
3 The challenges include the rapid pace, pre
op and post -op care be ng demanding, pain
5 That she must wear TEDs until fully mob le - 6 Can you tell me what operat ori you re
having today ?
management, and the cuick turnover of
d
7 Did you sign a consent form for the
patients.
Ic 2 d 3 a Ae 5 b
operation ?
A Laparoscopic or keyhole, surgery has 5a 8 Is this you? signature on the consent form?
become mere widespread. It shows a patient with DVT. 9 Have you had a pre - med?
5 Patients are prepared for abdominal 10 I'll sign the Checklist , anc you've already
surgery by naving a low residue diet for a b
got a theatre cap :o cover your hair
few days and then a clear fluid diet coupled I T
with an er.ema to ensure the bowel is
2 F - he had the symptoms after this Share your knowledge
operation Suggested answer
dear The abdominal area may be shaved
according to the surgeon ’s wishes 3 T 3 Having several checks before the patient
A F - only on the affected leg has an operation guards against: mistaken
b 5 F - he hasn’ t developed a pulmonary identity , the wrong operation being
2 d 3 a Ac 5 f 6 b embolism performed; lack of consent leading to a charge
d 6 F - he has warmth swelling and calf pam of negligence and/cr assault and battery ;
ootentially serious allergies being missed
1 Very anxious c
2 Keyhole surgery, also called minimally 1 c 2 d 3 a A b
invasive surgery tm Unit 9
3 A laparoscope
d
1 venodilation la
A Tne surgery is performed through three to Suggested answers
four small puncture sites instead of a long 2 embolus
5 embolism 2 Name of operation performed, any
incision complications, analgesia given in Recovery
A venous stasis
5 A couoie of nours any complications in Recovery, drams anc
6 Emma's swallow reflex e dressings n situ , new Prescr ptior. Charts
7 Soon after returning to the ward, when 1 normal blood flow (IV Irfusion Orders), medication orders and
Emrra thinks she can pass urine 2 DVT follow - up instructions All pre op charts also
3 embolus need to be handed back with new orders
e ,
A embolism on new charts, and the Operation Report

2 f 3 h Ad 5 a 6 c
? 6 8 b f 3 The Ward Nurse crosschecks the Operation
4a 1 Venous stasis caused by immobility .
Report . Prescription Chart Obs Chart, the
2 Vencdilation causes snail tears in the nner patient 's wound, drains and IV.
Suggested answers A All previous orders (Prescriotion Charts,
1 Sperd time explaining what Happens
walls of the ve ns
3 Blood becomes stickier and coagulates medication and dressings) have changed
n the pre op and post - op period so it 5 It's important to check for excessive blood
is more familiar Ensure that you have
more easily
A Formation of an embolus loss, pain level, dehydration, nausea and
uninterrupted time to discuss any vomiting , and loss of consciousness.
5 An embolus blocks o ood flow
concerns with your patient so that they
feci comfortable talking about them. Be b
9
aware of cultural or language factors which 2 heparin 1 He’s had a splenectomy.
may cause more anxiety and ensure an 3 subcutaneous 2 Because he was slow to wake up after his
interpreter is at hand if necessary. A warfarin operation .
.
2 Yes different strategies may be needed 5 DVTs . pulmonary embolism; lifelong 3 Because he had some post -op nausea and
vomiting .
depending on the needs of the particular 6 dose. INR
age group. 7 hiter A Yes. * t is patent and draining
5 Using clips
3 Strategies useful for a child allow the child
to touch equipment for example oxygen
6a .
6 No if is to be left intact for the surgeon to
.
masxs reassure the child that a parent will 1 Tne chart is used to check a patient before
going to an operation
review the next day.
.
7 Yes in Recovery
accompany them to the Operating Theatre
allow the child to take a special toy with b 8 He was feeling co: d and his temperalure
them or keep the toy to wait for the child 1 YES 2 YES 3 YES A YES was a bit low.
A Strategies for a patient who doesn’ t speak 5 NO 6 NO 7 NO 8 NO c
English ensure that an interpreter is 9 NO 10 YES II YES 12 N/ A 2 a 3 e A c 5 b 6 d
available to translate ycur instructions 13 YES 1A YES
and the patient’s questions, be culturally Fluid last given at 11 pm d
sensitive to any concerns the patient may Urine last voided at 10 20 am 2 13/ 15
have: allow the interpreter or relative Food last g ven at 6 pm 3 36 °
to accompany the patient to Operating Catheterised N / A A 72
Theatres 5 97
c 6 dextrose
b Name 7 patent
2 reassuring ID bracelet 8 Clips
3 normal Operation or procedure 9 NAD
A anxiety Consent form signed 10 75
5 avoid Pre - med given and signed for 11 oral
6 involve 12 redivac
13 intact
Answer key 117

2a d 6a
1 .
Mo he s still a oit hypothermic Listen calmly - use non-verbal communication I The chart is for rating pain intensity and
2 Some ice ch ps .- such as nodding the head, maintaining contains a number of different scales.
3 No, he fee s sick comfortable eye contact and making listening 3 The facial expressions, often called The
4 .
Mo he s in a lot of pan noises' to reinforce that you are interested in VVong-Baker faces, are used to rate the
5 .
Mo because he has a urinary catheter in what the speaker is saying level of pain felt by a child or a person who
situ Defuse the stuat on if possible - It’s OK HI is unable to communicate verbally because
6 He can use the ca l bell to call the nurse see what I can do HI be looking after Paul this of a language barrier or other problem
evening Can I ask who you ore first, please7 4 The numerical scale, which uses numbers
b
Speak quietly but hrmly I need you to lower from 0 (no pain) to 10 (worst pain imagined
2 e 3 h 4 g 5 b 6 d
7 f
your voice so we con folk about sorting out by the sufferer ); the verbal descriptor; and
8 a
Paul’s pom the activity tolerance scale
3a Rephrase - You’re worried that Pout isn’t 5 Pam leve s are subjective so it is important
1 Six a: rest seven on movement getting regvior pam relief Is thot right? that the patient be able to describe their
-
2 It red ees the amount of opioids needed
3 She gives him some analgesia, puts him in
-
Empathise / do understand, its hard, isn’t it?
-
Offer a solution Hon about I get his chart
pain.
a comfortable position, pulls the curtains now and see what he's been having7 b
and dims the lights 1 Stickers
Share your knowledge 2 Number three
b Suggested answers 3 A video game
1 hurt » Aggressive behaviour is a problem in
2 throbbing many countries Statistically, nurses are c
3 hurts more likely to oe attacked tha^ any other 2 f 3 a 4 b 5 e 6 c
4 stinging healthcare worners. d
5 knife 2 The reasons for aggression can be 1 don 't you7
c 'rustration with treatment, d ssatisfacbon 2 isn' f he?
with staffing levels, past history of
2 a 3 » 4 b 5 g 6 h 3 is he?
7 a 8 e aggression or having a short fuse, parents 4 doesn't it 7
with children in pa n. drug and alcohol 5 snail we 7
Share your knowledge withdrawal, feeiings of loss c 4 autonomy Sharon uses question tags to soften what she
Suggested answers especially when used to being in control of says and to inciude Arton in the conversation.
1 Pam can be described as aching, cramp ng
crushing throbbing, radiating.
. stuat ons fear of pam. dementia, different
f
images of nurses in different cultures
2 For example an aching knee, cramping 3 Initiatives include having a good ABM b 5 c 3 d 4 el f 6
period pain, crushing angina pain, programme in each hospital, good support g 7
throbbing headache radiating heart attack for nurses' safety from management, signs Share your knowledge
pam alerting patients that aggression towards 1 Other groups who can use t e Wong-
3 Pam behaviours include intermittent nursing staff will not be tolerated, cultural * who
Baker faces scale include anyone
moaning rubbing the affected area
, , awareness training regarding differing Mas difficulty verbalising due to lack of
grimacing, limping, constantly changing images of nurses language skills or as the result of an illness
position
5a such as dyspnasia.
4 These behaviours draw attention to their 2 The chart could be modified by using
pain.
1 An injury to the skin, for example a surgical
incision Braille so that visually impaired patients
5 Possible pain management problems could feel the faces.
induce sufferers feel that they are not 2 Visceral pain
,
3 Type A-deita and Type C 3 The faces could be modified to show
ta cn seriously and can become cu:e
*
host le. sufferers may not want to try new
4 Fast pain is acute and localised: slow pam is examples of emotions, for example anger, ,
aching and referred fear, grief or incomprehension

options for fear of an increase in pain,
constant moaning can make empathetic
5 Pair relief
response a challenge b
mm unit IO
4b 2 a 3 d 4 b 5 f 6 c la
Suggested answers
1 They are watching a patient and his visitors c 1 To avoid duplication of services, to ensure a
as the visiters appear to be becoming 1 nociceptor
agitated. hohscic approach to patient care
2 cutaneous 2 Communication problems poor sense of
2 He is upset that Paul is in pa n and thinks 3 visceral
the nurses are not helping him
teamwork
4 incision
5 They spea < calmly and offer to get Paul 5 localised pain b
some pam relief 6 referred pain 1 T
4 She asks him to lower his voice 2 F - they founo her uncoordinated
5 SHe reassures him that Paul is getting d 3 F - she’d had a stroke
regular pain relief and says she will talk to 2 c 3 h 4 g 5 d 6 b 4 F - it happenec tne night before
Paul about aler: ng tne nursing staff earlier 7 i 8 e 9 a 5 T
if the amount of pam medication is rot e 6 F - it is planned
enough 2 threshold 7 T
c 3 tolerance
4
c
2 defuse scale
1 Two weeks
3 Listen 5 non steroidal
2 To go back to her own home
6 morphine-like
4 Speak
5 Rephrase 7 Background
3 Monday 12 June .
4 The kitchen staff pureed food brought in for
6 Empathise 8 Multimodal
her
7 solution Share your knowledge 5 With her daughter. Larissa
8 alternative Suggested answer .
6 Friday 9 June
1 If pam isn't adequately treated it can affect
d
a patient’s ability to mobilise after surgery
2 a 3 b 4 c 5 c 6 b
or to do important post-os exercises.
Chronic pair can lead to depression.
118 Answer key
2a c e
l RN Andrea Dubois 1 hemisphere 1 The services required on return to home ,
7 Alexandra Hospital 2 carotid artery referrals for follow-up care, understanding

3 Her daughter, Larissa A ischaemia of medication regime. It is used during
b 6 ischaemic stroke the patient s stay in hospital to ensure a
7 haemorrhagic stroke smooth transition is made back home or to
2 Larissa
3 01265 6 AA 753 d another facility
A Hanif 2 Haemorrhagic 3 So a plan is put in place in time for the
5 bathing; mobility 3 hemispheres discharge date.
6 soft A branch out A A box with divisions so that medication for
7 No 5 oxygenated each day can be dispensed and the patient
8 Yes 6 cerebral does not have to take out medication from
9 12 June 7 deprived of individual bottles.
8 obstruct 5 Patient may not be supported and become
c isolated; especially important when
Suggested answers Aa patients live aione and do not have family
2 Challenging situations include: peoo:e with 1 T who can help them
a strong accent , people speaKing fast , 2 T 6 For emergencies
people not understanding you; forgetting 3 F - he has ^ appropriate emotional 7 Multi-disciplinary teams are groups of
how to say something in English . These responses and mood swings professionals from diverse disciplines who
situations can oe managed by : asking the A T come together to provide comprehensive
person to repeat/slow down /rephrase; 5 F - there is no hearing loss after a stroke care for the patient
rephrasing what you say in order tc be 8 To ensure that all members of the team
understood; checking pronunciation of b
2 f 3 g Ah 5 d work together , that no services are
words before you use them, and planning 6 b duplicated, and to ensure a complete
your phone call ahead of time 7 a 8 c
understanding of the patient’s progress
d c 9 To ensure that post - hospital instructions
la 2 a 3 a/ b 1 hemiparesis are understood, for example medicat on
A b
2 hemiplegia regimes outpatien: aopomrT.crts . and
,
f 3 hermanopia CP appointments Also, if the patient is

1 It can become quite labile A aphasia returning to their own home, to ensure that
2 The Key Worker 5 dysphasia heating is switched on and there is enough
3 Because of confidentiality 6 dysphagia food in the house (especia ly important in
A He suggests that Gillian calls the Discharge 7 dysarthria winter ]
Plann ng Nurse so she can discuss her 8 emotional lability
concerns
5a
9 Suggested answers
Suggested answers 1 To assess how ndeperdently a patient can
1 Callers know that nurses are busy arc perform basic daily activ ties
worry that they are taking them away from 2 Older adults, especially before placement in
their duties. a care home
2 Callers are sometimes unsure if they are 3 An independent, self - caring patient
talking to the right person. A A severely disabled or physica ly dependent
3 It 's sometimes difficult to locate the right patient
.
person to talk to ca:lers worry that the
phone call will be interrupted b
A This can happen when callers feel a little 2 j 3 e Ai 5 g 6 c
interior or have not had much expedience 7 d 8 a 9 f 10 h
dealing with the health system. c
5 Waiting times for treatment can be lengthy a fasteners
and callers are concerned that the same is b Mechanical transferring aids
true for enquiries. c Continent
6 Privacy laws are not always understood by a defecation / unnation
patients or relatives Older people may not e urination defecation
be aware of the changes to data protection f supervision
h g commode
b A c 6 d 2 el f 3
h transfer
i parenteral
Share your knowledge j incontinent
7 Patient records are kept out of easy access
to relatives or friends, usually behind the
d
Nurses Desk in a filing cabinet . Ernesta Bortoh
Bathing 0 Dressing 0 Toileting 0
3a Transferring 1 Continence 0 Feeding 1
Suggested answers Total Points 7
1 Weakness or paralysis on one $ »de of the She will be quite dependent, as she needs help
body, damage to the swallow reflex with bathing and toileting, including continence
2 Speech and language problems, nobility, assistance and dressing
change to behaviour patterns, visual
problems, loss of memory, etc
b
2 f 3 b Ae 5 c 6 a
7 a
139
Acknowledgements
The authors and publishers acknowledge the following sources of copyright material and are grateful
for the permissions granted. While every effort has been mader it has not always been possible to
identify the sources of all the material used, or to trace all copyright holders. If any omissions are
brought to our notice, we will be happy to include the appropriate acknowledgements on reprinting.
Photo acknowledgements
Alamy Andrew Holt p24 (I) , Chris Rout p6, Jupiter Images / Thinkstock p 34 . Carlos Davila p 35 (I) , Scott
Camazine p35 (tr) , VStock p 54
CMPI pH
CMSP p 24 (br )
Getty Images John Rensten p 70. Somus Veer p62 . Stockbyte p78 , Tetra p37 . The Image Bank / Lester
Lefkowitz p38. Stone / Hans Nelemar, P64
Mediscan p24 (r). p46. p69
Oxford Scientific Films p 22
Science Photo Library Dr P Marazzi p 24 (bl), Mark Thomas p30, Mark Thomas p81
Wellcome Library London p 35 (c) . p67
Author acknowledgements
The authors would especially like to express their gratitude to our editors Clare Sheridan and Sara Harden
at Cambridge University Press for their guidance and support during the writing of this book and
to Nick
Robinson for his invaluable support Our thanks to Candy Brown , Cheryl Alexander and Susanna Kuiper
for
their nursing input. Our appreciation to Sue Stone of Design Presence for her assistance in the layout
of our
initial ideas. Thanks to our families for their consideration of our absences whilst writing materials
. Patricia
would like to thank her family. Garry. Alexandra and Michael Virginia would like to thank her
children ,
Rodrigo . Paulo. Lydia and Henry*.
Publisher's acknowledgements
The authors and publishers would like to thank the following people who reviewed and commented on
the
material at various stages: Professor Debra Crcedy and Rosemary Villar RGN RM .
Designed and produced by eMC Design Ltd. www.emcdesign.org.uk .
Picture research by Alison Prior Audio production by John Green and Tim Woolf .
Cambridge English for is a new series of ESP courses for different areas of English for Specific
Purposes.
Written for professionals by professionals, these short courses combine the best in ELT
methodology with
real professional practice.
Other titles in the series:
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CAMBRIDGE

Cambridge English for

How to use Cambridge English for Nursing for self- study

Educating patients about asthma The respiratory system Respiratory rates

Discussing wound management Wound bed preparation Wound Assessment Chart

Discussing diabetes management The pancreas Diabetic Chart.

Explaining pathology tests The kidneys Pathology Report

Administering medication The metabolism of Prescription Chart

Pain receptors Universal Pain

page 70 Dealing with aggressive behaviour

Cerebrovascular accidents Telephone Referral Form

Role plays and additional material page 86

l a i n pairs, look at the picture and discuss the following questions.

b l.l Shona , the Ward Nurse, is admitting Mrs Chad. Listen

Communication focus: using active listening strategies

1 Using expressions such as Really ? , Is that right?, and Yes or

Unit 1 Patient admissions 7

THE ALEXANDRA HOSPITAL

PATIENT ADMISSION FORM

Reason for admission

Past medical history

Past surgical history

Share your knowledge

8 Unit 1 Patient admissions

the atria the valves the ventricles the pulmonary vein

How does your heart work?

Unit 1 Patient admissions 9

4 a u Listen to a conversation between a Nurse Educator, Susanna , and her

b Susanna uses several informal expressions to create a friendly and relaxed

1 have a chat a monitor

1 Sit at the as the patient . a This encourages patients in their attempts

e In pairs, practise putting a patient at ease. Student A , you are Susanna;

Share your knowledge

10 Unit 1 Patient admissions

5 3 In pairs, discuss the following questions.

Match the abbreviations ( 1- 14 ) to their meanings (a- n) .

Unit 1 Patient admissions 11

THE ALEXANDRA HOSPITAL JW U/ N: 732910

/ Vs Smits do chest pain at ZZOOhrs. SHO

Mrs Smits ( 1 ) o-P chest pain at ( 2) .

12 Unit 1 Patient admissions

h In pairs, practise giving a handover using the Patient Record . Student A ,

Charting blood pressure and pulse

c l.6 Some of the information in the Obs. Chart on page 86 is incorrect .

e Look at Mrs Small’s handover in the audioscript on page 94 and find

Unit 1 Patient admissions 13

b ll Eleanor is an Asthma Clinic Nurse. One of her

C M Listen again and complete the following extracts.

14 Unit 2 Respiratory problems

f Find the instructional language in the audioscript on page 95 . What do you

Communication focus: giving instructions effectively

b Complete the strategies for giving instructions effectively ( 1 — 8) using the

1 Put the listener at ease by using positive non-verbal communication such as

5 Use a level of language which can be _ by the listener.

Unit 2 Respiratory problems 15

C Match the beginnings ( 1 - 5 ) to the endings (a-e ) to complete Melanie ’s

G In pairs, practise giving instructions on how to use a nebuliser. Student

Share your knowledge

16 Unit 2 Respiratory problems

alveoli throat or pharynx windpipe or trachea oral cavity

6 f kv- Q <?if /pUgnvyn

b In pairs, look at the pictures of a healthy airway and an

Healthy airways Asthmatic airways