北京市版权局著作权合同登记号 图字：01-2021-1549 . licensed by ELI s.r.l, Italy — ELI Publishing. www.elionline.com Author: Adrienne Harrison The English adaptation rights arranged through Rightol Media. （本书英文改编版版权经由锐拓传媒取得） 版权所有，侵权必究。举报：010-62782989，beiqinquan@tup.tsinghua.edu.cn。 图书在版编目（CIP）数据 护理英语 / 姜宏总主编；刘玥主编. —北京：清华大学出版社，2021.4 新时代行业英语系列教材 ISBN 978-7-302-57792-8 Ⅰ. ①护… Ⅱ. ①姜… ②刘… Ⅲ. ①护理学-英语-高等职业教育-教材 Ⅳ. ①R47 中国版本图书馆 CIP 数据核字（2021）第055448号 策划编辑：刘细珍 责任编辑：刘　艳 封面设计：子　一 责任校对：王凤芝 责任印制：丛怀宇 出版发行：清华大学出版社 网 址：http://www.tup.com.cn， http://www.wqbook.com 地 址：北京清华大学学研大厦A座 邮 编：100084 社 总 机：010-62770175 邮 购：010-62786544 投稿与读者服务：010-62776969， c-service@tup.tsinghua.edu.cn 质 量 反 馈：010-62772015， zhiliang@tup.tsinghua.edu.cn 印 装 者：北京博海升彩色印刷有限公司 经 销：全国新华书店 开 本：210mm×285mm 印 张：8.25 字 数： 198千字 版 次：2021年4月第1版 印 次：2021年4月第1次印刷 定 价：55.00元 产品编号：091249-01 序 在经济全球化和国际交往日益频繁的今天，无论是作为个人还是组织的一员，参与国际交流 与合作都需要具备良好的外语沟通能力和扎实的专业技术能力。高职院校承担着培养具有全球竞争 力的高端技术人才的使命，需要探索如何有效地培养学生的行业外语能力。行业外语教学一直是职 业院校的短板，缺少合适的教材是其中一个主要原因。目前，国内大多数高职院校在第一学年开设 公共英语课程，所用教材多为通用英语教材，其主题与学生所学专业的关联度总体较低；部分院校 自主开发的行业英语教材，在专业内容的系统性、语言表达的准确性等方面存在诸多不足；还有部 分院校直接采用国外原版的大学本科或研究生教材，但这些教材学术性和专业性太强，对以就业为 导向的高职院校学生来说，十分晦涩难懂。 清华大学出版社从欧洲引进原版素材并组织国内一线行业英语教师改编的这套“新时代行业 英语系列教材”，以提升学生职业英语能力为目标，服务师生教与学。本套教材具有如下特点： 一、编写理念突出全球化和国际化 本套教材在欧洲原版引进优质资源的基础上改编而成，全球化视角选材，结合行业领域和单 元主题，关注环境保护、人口老龄化、贫困等时代难题，培养学生的国际视野和世界公民素养。单 元主题、板块编排和练习设计与国际接轨，体现国际规范和国际标准，且反映全球行业发展动态和 前景，帮助学生全面了解全球行业现状和掌握国际操作流程，夯实行业知识体系。 二、编写目标注重培养学生使用英语完成工作任务的实际应用能力 为响应高职院校外语教学改革号召，培养具有国际竞争力的高端技术人才，将外语教学目标 由原来的语言能力导向转变为职业能力导向，本套教材通过听、说、读、写、译等基本语言技能 训练，让学生完成不同行业领域的工作任务，将英语放到职场的背景中来学，放到员工的岗位职 责、工作流程中来学。 三、结构与内容紧扣行业领域的职场情境和核心业务 本套教材围绕行业核心概念和业务组织教学单元，不同单元相互关联，内容由浅入深、由易 到难，循序渐进；教材各单元主题契合行业典型工作场景，内容反映职业岗位核心业务知识与流 程。每本教材根据内容设置 8 至 10 个单元，用多种形式的语言训练任务提升学生对行业知识的理 解与应用。 序 i 四、资源立体多样，方便师生教与学 本套教材图文并茂。通过改编，在原版教材基础上每个单元增加了学习目标，明确了学生在完 成各单元学习后应该达到的知识和能力水平；增加了重点词汇中文注释和专业术语表，便于学生准 确理解行业核心概念；听力练习和阅读篇章均配有音频，并借助二维码扫码听音的形式呈现，实现 教材的立体化，方便学生学习；习题安排契合单元的主题内容，便于检测单元学习目标的实现 程度。教材另配有电子课件和习题答案，方便教师备课与授课。教师可以征订教材后联系出版社 索取。 本套教材共 10 本，包括《护理英语》《机电英语》《建筑工程英语》《运输与物流英语》 《烹饪、餐饮与接待英语》《旅游英语》《银行与金融英语》《市场营销与广告英语》《商务英语》 《商务会谈英语》，涵盖医药卫生、机电设备、土木建筑、交通运输、旅游、财经商贸等六大类专 业。建议高职院校结合本校人才培养目标，开设相应课程。 本套教材适合作为高职院校学生的行业英语教材，也适合相关行业从业人员作为培训或自学 教材。 姜宏 2021年3月31日 ii 护理英语 前言 近年来，外资医疗护理机构、国际医院日益发展，这对护理专业人员的英语语言能力提出了 更高的要求，护理行业的英语教材也要顺应客观形势和行业需求不断完善，为培养与国际接轨的护 理专业应用型人才发挥重要作用。新时期的高职护理专业英语教材要突出职场语言素养，同时培养 学生的创新能力、前瞻视野和社会责任感。 《护理英语》在原版引进教材的基础上进行改编，以提高高职高专护理专业学生职业素养为 目标，以护理岗位专业知识和护理工作内容为主线组成教学单元，以规范的行业英语表达为基础， 护理学专业知识和英语语言技能并重。本教材共分为10个单元，涵盖职业角色、分科就诊、情况鉴 别分类、感染防治、卫生护理、饮食营养、呼吸疾病护理、外伤护理、药品服用、老年病人和糖 尿病人护理等领域，内容翔实。每单元均有明确的学习目标，对重难点单词进行了词性和词义注 释，另有“护理与社会”阅读栏目介绍护理行业发展及医疗健康等热点话题。 本教材的主要特点如下： 1. 从护理专业的英语教学实际出发，各单元根据主题设计了听说、阅读、写作和文化板块， 遵循“激活—输入—输出—开放”的探究式习得规律，构成完整的知识体系。知识分布点面结合， 旨在帮助学生提高语言综合应用能力。 2. 精选国内外护理行业发展动态和人口老龄化等全球性问题的相关新闻报道，培养学生的行 业前瞻性，开阔专业视野。 3. 重视语言材料的真实性，专业词汇丰富，图文并茂，直观呈现。 本教材由刘玥担任主编，负责第一、二、四、五、六单元的编写；李思担任副主编，负责第 三、七、八、十单元的编写；黄荣参编，负责第九单元的编写；刘莉副主编负责案例编辑。总主编 姜宏教授全程指导并参与教材的审订工作。本教材可以作为高职高专和应用型本科护理英语课程的 专业教材，也可作为有意愿提高护理英语水平人士的学习用书。 由于编写人员水平所限，不妥之处在所难免，敬请读者批评指正。 编者 2021年3月 前言 iii Contents Unit Topic Vocabulary Skills 1 Reading about different nursing roles Listening about nursing job description Speaking about nursing situation Writing about nursing job application . Parts of the body . Body systems . Conditions and complaints . Areas of specialisation . Nursing roles and duties . Workplaces Nursing Roles p. 2 2 In the Hospital Section 1 Reading about hospital departments, wards and each nurse’s duties Listening about hospital reception and ward description Section 2 Reading about emergency admission and programmed admission Listening about admissions Speaking and writing about admission form Section 1 . Staff and departments . Ward equipment Section 2 . Programmed or elective admission . Emergency admission . Dates and numbers . Admission forms p. 12 The Triage Nurse and Monitoring Vital Signs Reading about the triage nurse, body temperature, different types of thermometers, blood pressure and neurological assessment Listening about triage colour-coding system, the pulse, Glasgow Coma Score table, blood pressure, neurological assessment and service dialogue Speaking about triage service Writing about skin burns levels 3 . Emergency treatment . Triage colour-coding . Heartburn and angina pectoris . Neurological assessment . Description of pain and adjectives about body parts . Medication and medical equipment p. 26 4 Reading and listening about cross infection Reading about differences between cross infection and secondary infection Listening about Dr. Semmelweis and handwashing Speaking about handwashing Writing about infection process Preventing Cross Infection . Cross infection . Bacteria . Handwashing . Universal precautions p. 42 5 Section 1 . Urination . Urinary elimination/ incontinence . Urinalysis . Bladder Section 2 . Bed-baths . Toiletries and equipment . Symptoms/conditions . Parts of the mouth Assisting the Patients Section 1 Reading about urination and urinalysis Listening about managing urinary incontinence and urinalysis Speaking about appropriate urination methods for patients with a medical condition Section 2 Reading about assisting patients with personal hygiene Listening about bathing a patient Speaking about problems edentulism can cause and personal hygiene needs Writing about opposite words application p. 52 护理英语 iv Unit Topic Vocabulary Skills Diet and Nutrition 6 . Food groups . Nutrition . Conditions . Feeding methods Reading about a healthy diet and what the elderly won’t eat Listening about childhood obesity Speaking about dietary issues Writing about children nutrition p. 66 Reading about physiological processes that cause asthma symptoms, instructions for the Ventolin asthma inhaler, pulse oximetry, and lung health Listening about gaseous exchange and respiration rate Speaking about pathology of asthma and using an inhaler Writing about measuring respiration rate 7 . Respiratory system . Medication . Equipment . Conditions and symptoms Respiratory Care p. 78 . Skin cell and medical equipment . Skin injuries . Wound healing . Wound assessment Wound Care 8 Reading about the process of wound healing and care for wound Listening about wound assessment Writing about wound types p. 90 . Types of drugs . Forms of administration . Medication . Controlled drugs . Injection . Side effect Administering Drugs Reading about controlled drugs and injection Listening about oral route and side effects Speaking about the advantages/disadvantages of different types of medications Writing about a medication and its side effects 9 p. 100 Geriatric Patient Care and Diabetic Patient Care Section 1 . Geriatric diseases Section 2 . Diabetic diseases Section 1 Reading about elderly people’s longevity and mobility Listening about conditions with the symptoms Writing about problems elderly people are likely to face Section 2 Reading about different types of diabetes and management of diabetic patients Listening about diabetes and advice on living with diabetes 10 p. 112 Contents v UNIT Nursing Roles 1 2 护理英语 Learning Objectives Upon completion of the unit, students will be able to: . name the organs and body systems in English; . recognise different nursing roles; . describe main nursing duties in English. Starting Off 1 Work with a partner. Label the pictures with the words from the box. head neck shoulder hair chest arm hand leg knee abdomen ankle hip buttock foot elbow toe eye nose ear 2 Match the body systems to the illustrations. 8) 13) 1) 14) 9) 2) 3) 15) 4) 16) 5) 17) 18) 10) 6) 11) 12) 19) 7) 1) _ respiratory system 2) _muscular system 3) _digestive system 4) _skeletal system 5) _nervous system 6) _cardiovascular system a b c d f e 3 Complete the table with the words or phrases from the box. spinal cord arteries nose femur stomach pelvic bones lungs veins ribs brain biceps heart nerves liver bronchi trachea gall bladder blood skull intestine calf muscles abdominal muscles nerve endings pectoral muscles Skeletal System Nervous System Cardiovascular System Respiratory System Digestive System Muscular System 4 Label the picture with the words from the box. bladder urethra kidney ureter 1) 2) 3) 4) Reading 5 Read about different nursing roles and complete the text with the words or phrases from the box. theatre nurses adult nurses school nurses neonatal nurses mental health nurses paediatric nurses learning disabilities nurses midwives Careers in Nursing (1) ________________ work with newborn babies who are born sick or prematurely. Often, premature infants have breathing problems which can be life-threatening if they are not treated promptly and monitored. Also, ill babies must be fed in a specialised way in a hygienic environment that is warm. These patients have a wide range of physical and mental health conditions so (2) ________________ work with the patient, the family and carers for the health and social inclusion of people of all ages with a learning disability. (3) ________________ face a complex and difficult area, working with GPs, psychiatrists and psychologists to care for patients with mental illness. Conditions range from personality and psychological disorders to neuroses and psychoses. The (4) ________________ face a wide range of situations, including babies with heart complications, teenagers with broken limbs and child protection. Health problems can affect a child’s development socially and educationally so the nurse’s role is important. (5) ________________ work with adults with diverse health conditions. They work in hospitals, clinics or in the community. Many patients are elderly, others have disabilities or have a terminal illness so it may involve shift work to provide 24-hour care. (6) ________________ are specialised nurses who assist mothers and newborn babies during and after the birth. They give advice on hygiene, breastfeeding and the post-natal well- being of the mother and baby. They work both in hospitals and in the community. (7) ________________ usually work for the national health service (NHS) or schools. They provide health and sex education in schools, carry out developmental screening (testing all students) and administer immunisation programmes. (8) ________________ are qualified nurses that have completed additional training to care for patients of all ages at the different stages of surgery. Based in hospital, they work in operating theatres, anaesthetic/recovery areas and on specialised wards. MY GLOSSARY premature adj. 过早的；未成熟的 threatening adj. 威胁的，恐吓的 monitor v. 监控，监测 n. 监控器，显示器；监 督员 specialised adj. 专门的，专科的 hygienic adj. 卫生的 physical adj. 身体的，肉体的 mental adj. 精神的，思想上的 disability n. 残疾，缺陷 GP n. （为特定区域居民提 供医疗服务的）全科医 生，普通医师（General Practitioner的缩写） psychiatrist n. 精神病医生 psychologist n. 心理学家 personality n. 个性，性格；人格 neuroses n. 神经官能症（neurosis 的复数形式） psychoses n. 精神病（psychosis的复 数形式） complication n. 并发症；复杂，复杂化 diverse adj. 多种多样的 terminal adj. （疾病）晚期的，致命的 n. 站台；候机楼 post-natal adj. 分娩后的，产后的 screening n. 测试，检查 administer v. 给予，施用；料理，管理 surgery n. 外科手术；诊室 anaesthetic n. 麻醉剂 6 Match the words and phrases with their definitions. 1) limbs a doctor who cares for people in the community 2) team b old (polite) 3) midwives c the place where doctors operate on patients 4) elderly d dangerous, potentially causing death 5) feed e a group of people who work or play sport together 6) theatre f nurses who assist during and after birth 7) General Practitioner g arms and legs 8) life-threatening h to give nutrition 7 Find the words in green in the text in Exercise 5 and match them with their definitions or synonyms below. 1) a period of work (usually 8 or 12 hours) in a 24-hour day ____________________ 2) vaccination ____________________ 3) phases ____________________ 4) respiratory ____________________ 5) baby ____________________ 6) disease (3 words) ____________________ 7) immediately/quickly ____________________ 8) help ____________________ 9) where patients sleep in hospital ____________________ 8 Read the text in Exercise 5 again. Are the following sentences true (T) or false (F)? T F　　　　 1) All nurses do shift work. 　　　　 2) Some nurses must have extra qualifications. 　　　　 3) Children’s nurses work with newborn babies. 　　　　 4) School nurses work privately. 　　　　 5) Premature babies can have very serious health problems. 　　　　 6) Nurses often give advice on medical problems. 　　　　 9 Label the photos with the activities from the box. applying a dressing ear syringing taking a swab 2) ________________________________ 1) _________________________________ 3) ________________________________ 10 Read the text and complete the duties that are mentioned. Practice nurses work with GPs (General Practitioners) in their surgery (the place where a General Practitioner or family doctor meets and treats patients) as part of a team. Their duties include running clinics for conditions such as asthma, diabetes, heart problems and skin disorders, offering advice on family planning and contraception, taking blood and urine samples and other specimens and swabs, routine procedures such as ear syringing, applying and removing dressings and treating wounds, offering specialist information and advice on blood pressure, weight control and stopping smoking, carrying out infant injections, vaccinations and travel immunisations, and giving advice to patients with long-term medical needs. MY GLOSSARY asthma n. 气喘，哮喘 diabetes n. 糖尿病 disorder n. 失调，紊乱；混乱，杂乱无章 contraception n. 避孕（法），节育 （法） sample n. （医生或科学家检测用 的）样本，试样；样品 1) Running _____________________________________________________________________________________ 2) Offering ______________________________________________________________________________________ 3) Taking ________________________________________________________________________________________ 4) Applying ______________________________________________________________________________________ 5) Giving ________________________________________________________________________________________ specimen n. （用于化验的）血样，尿 样；样本，标本 swab n. 拭子，消毒棉签；用药签取 下的化验标本 routine n. 惯例，常规；例行公事 procedure n. 医疗处理；手术；程序，步骤 ear syringing （用注射器）进行耳朵灌洗 dressing n. （包扎伤口用的）敷料，纱 布；调料，佐料 blood pressure 血压 weight control 体重控制 injection n. 注射；投入 vaccination n. 疫苗接种 immunisation n. 免疫接种 11 Complete the sentences with an appropriate verb from the box in the correct form. affect be work have (x2) eat continue risk 1) Practice nurses ____________________ with a GP. 2) The baby ____________________ in an incubator. She ____________________ breathing problems. 3) Premature babies ____________________ complicated feeding problems. 4) The patient ____________________ too much and ____________________ becoming obese. 5) Many patients ____________________ to smoke against the GP’s advice. 6) Health problems ____________________ a child’s progress at school. Listening 12 Listen to Fiona speaking about her job as a nurse and complete her duties. 1) Disinfecting __________________________________________________________________________________ 2) Changing ____________________________________________________________________________________ 3) Measuring ___________________________________________________________________________________ 4) Giving _______________________________________________________________________________________ 5) Taking _______________________________________________________________________________________ 6) Checking ____________________________________________________________________________________ Speaking 13 Who are the people in the photos? 1) Where would you work with these people? (in a hospital, in a residential care home, in the community) 2) Which nursing situation do you prefer and why? a _____________________ b _____________________ c _____________________ d _____________________ Writing 14 Write your own statements based on your responses to these typical nursing job interview questions. 1) Where did you get your training and what qualifications do you have? 2) Describe your relevant nursing experience. 3) Why are you the right person for this nursing job and why should we hire you? 4) Why are you interested in this particular nursing job? 5) What have been your most significant accomplishments to date? 6) What are three strengths that you bring to this nursing position? 7) What are your future goals? 8) Why did you choose your specialty area of nursing? 9) Why do you want to work in our hospital and/or community? 10) How do you stay current with the nursing profession? Nursing and Society Improve Your Nursing English Affixes are groups of letters that are added to the beginning or the end of words to make new words. Prefixes go at the beginning of words and often change meaning, while suffixes go at the end of words and often change the part of speech of a word (e.g. from verb to noun, or noun to adjective, etc.). Common prefixes and suffixes provide a foundation for learning medical terms. Focusing on the important word parts will help you memorise complex medical terminology. The following are some affixes you may find helpful in learning nursing English. Prefixes: andro – man osteo – bone hepato – liver paedia – child nephro – kidney neuro – nerve/brain derma – skin arth – joints pneumo – lung cardio – heart gastro – stomach sclero – hard/rigid entero – intestine haemo – blood ocul/ophthal – eye myo – muscle ot – ear gynaeco – woman rhino – nose Suffixes: . ist (e.g. cardiologist) – the person who specialises in an activity . algia (e.g. cephalgia) – pain/ache . itis (e.g. conjunctivitis) – inflammation and/or infection . oma (e.g. melanoma) – tumour or swelling . pathy (e.g. cardiopathy) – a disease or condition . ology (e.g. cardiology) – the study of a certain subject Examples: . All women should go to the gynaecologist for a check-up regularly. . There are many geriatric patients who suffer from dementia and other age-related diseases. . Diarrhoea, vomiting and fever are symptoms of gastroenteritis. . Hepatitis is a common infection in intra-venous drug addicts. . A tumor or protuberance in the muscle tissue is called a myoma. . A disease affecting the nerves is known as neuropathy. . The study of the respiratory system is known as pneumology. . A brain/nerve specialist is called a neurologist. Discussion How will the knowledge of affixes help you improve your nursing English? UNIT In the Hospital 2 Learning Objectives Upon completion of the unit, students will be able to: . master the English terms for hospital departments and units; . describe medical objects in English; . recognise the differences in emergency admission, elective admission and treatment in A&E; . clarify patients’ information in English. Section 1 Hospital Department and Equipment Starting Off 1 1 Match each of the following terms with its Chinese translation. 1) paediatrics unit 2) obstetrics and gynaecology department 3) general surgery ward 4) haematology department 5) neonatal department 6) intensive care / high dependency unit 7) maternity ward 8) geriatrics unit 9) accident and emergency (A&E) unit 10) pharmacy 11) operating theatre 12) orthopaedics department 13) radiology department 14) neurology department 15) outpatient a 放射科 b 神经科 c 新生儿科 d 重症监护室 e 门诊病人 f 药房 g 手术室 h 妇产科 i 普通外科病房 j 血液科 k 儿科 l 老年病科 m 急诊室 n 产科病房 o 骨科 Reading 1 2 Read the text and complete the table. Hospitals are divided into departments and/or units. Each department or unit has wards where the patient beds are located. The nurse who is responsible for a ward is called the ward sister. Auxiliary or ancillary nurses help the patients to wash, eat, go to the bathroom or use a bed pan. The head doctor of each department or unit is known as the chief consultant. Surgeons, the doctors who carry out operations, may work in general surgery or may be specialists in a specific area such as cardiac surgery or neurosurgery. Position Duties this person operates on patients this person supports nurses and patients this person is responsible for a department or unit this person is responsible for the ward MY GLOSSARY divide v. 分组；分摊；分隔 ward n. 病房；牢房 locate v. 位于……，坐落于……；确 定……的位置 responsible adj. 负责的；可靠的 auxiliary adj. 辅助的 n. 辅助人员 ancillary adj. 辅助的，补充的；附属的，附 加的 patient n. 病人 adj. 有耐心的，忍 耐的 chief adj. 首要的，最重要的 n. 领导人，首领 consultant n. 高级顾问医师；会诊医师； 医学专家 surgeon n. 外科医生 operation n. 手术；运作，实施 specialist n. 专科医生；专家，专业人员 cardiac adj. 心脏的，心脏病的 3 Match each symbol with the correct hospital department. a b c d 1) _maternity 2) _accident and emergency 3) _orthopaedics 4) _radiology 4 Complete the sentences with words or phrases from the box. paediatrics obstetrics and gynaecology general surgery ward haematology neonatal intensive care / high dependency maternity ward geriatrics pharmacy accident and emergency (A&E) operating theatre orthopaedics radiology neurology outpatient 1) Conditions related to the female reproductive system are treated in the ________________________ department, often known as Obs & Gyn. 2) Elderly people are often treated in the ________________________ unit. 3) A surgeon works in a(n) ________________________ with a team including theatre nurses and an anaesthetist. 4) Mothers and their newborn babies stay in the ________________________. 5) Patients with severe trauma are treated in the ________________________ unit. 6) Drugs are dispensed in the ________________________. 7) Suspected fractures are examined in the ________________________ department. 8) Premature babies are cared for in the ________________________ department. 9) Patients with mobility issues are dealt with in the ________________________ department. 10) After an operation, most patients recover in the ________________________. 11) Patients suffering from memory loss, fits or paralysis are examined in the ________________________ department. 12) Children are admitted to the ________________________ unit or hospital. 13) Blood samples are examined in the ________________________ department. 14) Ambulances take patients to ________________________ unit. 15) Patients who attend the ________________________ clinic are treated in hospital but do not sleep there. 5 Label the objects with words or phrases from the box. pillow bed pan sharps bin drip stand locker thermometer patient chart medicine trolley gloves call bell needle stethoscope 1) ___________________ 2) ___________________ 3) ___________________ 4) ___________________ 6 Complete the sentences using the vocabulary in Exercise 5. 1) Every evening the nurse will bring the _________________ to give you medication. 2) You will sleep better with your head on one _________________, not two, Mrs Harvey. 3) Your books and money are in the _________________ Mr Rashid. 4) If you have a problem, just press the _________________ and a nurse will come. 5) We have to take your temperature. Put the _________________ under your arm, please. 6) If you can’t walk to the toilet, you can use the _________________. 7) Your medical notes are updated constantly on the _________________. 8) It is important to use new sterile _________________ with every patient. 9) The _________________ holds a bag that gives the patient fluids and medication intravenously. 10) Put the needle in the _________________, please. 8) ___________________ 5) ___________________ 6) ___________________ 7) ___________________ 12) __________________ 9) ___________________ 11) ___________________ 10) __________________ Listening 1 7 Listen and complete the dialogue. Receptionist: Good morning. How can I help? Visitor: I’m looking for the (1) _________________ department. Receptionist: Ah, see the corridor (2) _________________? 8 Mark the radiology and orthopaedics departments on the hospital plan after listening to the dialogue in Exercise 7. 9 Read the text below to complete the hospital plan in Exercise 8. The obstetrics and gynaecology department is next to reception. The haematology department is between the orthopaedics department and the obstetrics and gynaecology department. The paediatrics unit is next to the surgery unit. Surgery is opposite the obstetrics and gynaecology department. Visitor: Yes, (3) _________________ the vending machine? Receptionist: Okay, go (4) _________________ the corridor to the end and (5) _________________ into a hall. Cross the hall. On the (6) _________________ side is a door. Go (7) _________________ the door and you will find the radiology department. It’s (8) _________________ of the orthopaedics department. Visitor: Is there anywhere I can buy something to eat? Receptionist: We only have the vending machine (9) _________________ the hospital but if you go and turn (10) _________________ there is a café that sells take-away sandwiches. It’s on the corner, (11) _________________ the bank. Visitor: Thank you. Receptionist: You’re welcome. MY GLOSSARY obstetrics n. 产科学 gynaecology n. 妇科学 haematology n. 血液病学 orthopedics n. 骨科；矫 形外科学 paediatrics n. 儿科学 10 Complete each of the sentences with a suitable preposition based on the floor plan in Exercise 8. 1) The hall is _______________ the radiology department and surgery. 2) The paediatrics unit is _______________ the right of surgery. 3) Haematology is _______________ the end of the corridor on your left. 4) The vending machine is _______________ reception. 5) Walk _______________ the corridor. Surgery is on your right. 11 Listen, mark the word stress and repeat. 1) gynae co logy 2) dependency 3) neurology 4) emergency 5) accident 6) haematology 12 Listen and complete the description. On the (1) _________________ of the bed there is a monitor and some equipment. (2) _________________ the monitor table and the bed there is a (3) ____________________. On the right of the (4) ___________________ there is a locker. There are (5) ___________________ glasses (6) _________________ the locker. There are two (7) _________________ on the bed. On the (8) _______________ of the bed there is a cover. Section 2 Admissions Starting Off 2 13 What do E.M. and P.A. stand for in hospital admission? 14 Read the text and look at the photos that show patients arriving at hospital. Describe the photos. Who are the people in the photos? What are they doing? Which situation is the most serious? Programmed or elective admission to hospital happens when you and your doctor know that treatment is necessary and a hospital appointment is organised. Emergency admission is when admission is not planned and when the patient’s condition is very serious. Patients who need immediate treatment but do not need to stay overnight in hospital also go to the emergency department. MY GLOSSARY program v. 为（计算机）编程；编 制……的程序 n. （计算机）程序；编码指令 elective adj. 非急需施行的；选举的；可 以选择的 admission n. 准许进入，入场；承认，供 认，招认 treatment n. 治疗，医治；对待，处理 appointment n. 预约，约定；任命，委派 organise v. 安排，组织，筹划；整理 emergency n. 紧急情况，不 测事件，突发 事件 condition n. 疾病；状况，状态 serious adj. 严重的，糟糕的；严肃的， 认真的 immediate adj. 立即的，即刻的；接近的， 紧接的 overnight adv. 一夜间，在夜间，在晚上 Reading 2 15 Read situations a–h and write E.M. (emergency admission) or P.A. (programmed/ elective admission) according to the patient’s situation. a You have a known medical condition that requires treatment or surgery. _______ b The admission can wait until a time that is convenient both for you and for the doctors. _______ c You will come to the hospital’s admitting office, not to the accident and emergency department. _______ d You may be instructed to go to the hospital in advance for X-rays, electrocardiograms (ECG), or other prescreening tests. _______ e If you require surgery and may need a blood transfusion, you can donate blood in advance. _______ f You will go to the emergency department. _______ g You may be brought by ambulance with paramedics. _______ h You may be admitted to a specialised unit (for example, surgical intensive care unit). _______ MY GLOSSARY convenient adj. 方便的，便利的 instruct v. 指示，命令，吩咐； 讲授 in advance 预先，事先，提前 X-ray X射线 electrocardiogram n. 心电图 transfusion n. 输血； 注入 donate v. 捐赠，捐献 paramedic n. 护理人员，医务辅 助人员 intensive adj. 密集的，集中的，加 强的 16 What is appropriate in these situations, emergency admission, elective admission or treatment in A&E? Why? 1) severe haemorrhage in a pregnant woman _________________________________________________ 2) cataract operation _________________________________________________ 3) asthma attack _________________________________________________ 4) broken nose _________________________________________________ 5) varicose vein removal _________________________________________________ 6) anaphylactic shock _________________________________________________ 7) burn on hand _________________________________________________ 8) heart attack _________________________________________________ 17 Complete the questions with wh- words. Then match them with the answers. 1) W____________ is your national insurance number? 2) W____________ is you name? 3) W____________ was your last appointment? 4) W____________ is your next of kin? 5) W____________ do you want to see the doctor? 6) W____________ is your date of birth? 7) W____________ do you live? 8) W____________ did you first notice the pain? 9) W____________ is your job? 10) W____________ have you taken for the pain? a _My wife, Mariella Dellaway. b _ I have a terrible pain in my head that is getting worse. c _Frank Dellaway. d _Three months ago. e _Belview Road, 65 Belview Road. f _ The tenth of October, nineteen sixty two. g _NH248533N h _I’m a computer analyst. i _ It started at the weekend, so five days ago. j _Paracetamol. Listening 2 18 Listen to a conversation between the admissions nurse and a patient and answer these questions. 1) Is the patient an elective or an emergency admission? 2) Has she had any tests? 3) Is she being admitted for tests? 4) Does she ask the admissions nurse any questions? 19 Listen again and complete the spaces in the conversation. Nurse: Good morning, Mrs Mir. We have to (1) _________________ some details and fill in the (2) _________________ forms before you can be admitted. Mrs Mir: Certainly nurse, go ahead. Nurse: (3) _________________’s your full name? Mrs Mir: Uzma Aysha Mir. Nurse: Could you spell Uzma for me, please? Mrs Mir: U-Z-M-A Nurse: And what’s your (4) _________________? Mrs Mir: 15th October 1975. Nurse: What’s the name of your (5) _________________? Mrs Mir: Dr. Allison De Sousa. Nurse: Now, I know you came to the hospital (6) _________________ week for some tests. And we asked you about any allergies and your medical (7) _________________. Mrs Mir: Yes, that’s right. Blood tests, (8) _________________ tests and an ECG. Nurse: Yes, we have the (9) _________________ here. Everything seems fine. Now, we need the name of your (10) _________________ and a contact number just for the books. It’s a (11) _________________ operation but we will need you to sign this consent form. Could you read it carefully, please? Mrs Mir: Of course. Nurse: Is there anything you’d like to ask me? Mrs Mir: Yes. I was wondering how long I’ll be in hospital after the (12) _________________. Nurse: (13) _________________ depends on how you react to the anaesthetic and how you feel, but it shouldn’t be more than a (14) _________________. That’s all the paperwork finished. Mrs Mir: Where do I go now? Nurse: Take a seat in the (15) _________________ and one of the nurses will call you. Mrs Mir: Thank you very much. Nurse: You’re (16) _________________, Mrs Mir. If you need anything, just ask. 20 Complete each sentence with a word or phrase from this unit. Then listen and check your answers. 1) The _________________ will help you to wash, Mrs Evridou. 2) Please read the _________________ carefully and sign it. 3) Don’t worry Mr Renzetti. It’s a _________________ operation. 4) The _________________ gave the patient oxygen in the ambulance. 5) I have an _________________ to penicillin. Please note that down, nurse. 6) At the _________________ of the chest pain, what was the patient doing? 7) If you need more information about the ward, ask the _________________ . 8) I see from your _________________ that you’ve suffered from high blood pressure for many years, Mr Friedrich. 9) Your medical treatment is recorded on the _________________ at the foot of the bed. 10) Hello Mr Jones. I am Dr. Bashin, the _________________ who is going to operate on you. Speaking Dates and Numbers . When we say telephone numbers, insurance numbers or codes in English, the digits are pronounced individually. 208974 is read “two oh eight nine seven four” (the number 0 is also read “zero”). 300435 is read “three oh oh four three five” (more common in British English) or “three zero zero four three five” (more common in American English). . Years are divided into two groups of two. 2012 is “twenty twelve” and 1978 is “nineteen seventy-eight”. Years below ten, such as 2009, are said “twenty oh nine” or “two thousand and nine”. . Dates are said using ordinal numbers, like first, second, third, fourth, fifth, nineteenth, twenty- sixth, thirty-first, etc. 31/12/1987 is “the thirty-first of December, nineteen eighty-seven”. 21 Take turns and dictate the following numbers/dates. Student A 1984 0815563478 22/09/1998 2013 7136829005 Student B 1976 0612354986 18/09/2011 2001 6854398267 Writing 22 When you are admitted to hospital, the nurse or admitting officer will ask you questions to complete an admission form. Complete the admission form based on your experiences. (what) Name ____________________________________________________________________________________ (what) Surname _________________________________________________________________________________ (when) Date of birth _____________________________________________________________________________ (what) National Insurance Number ______________________________________________________________ (who) Name of GP ______________________________________________________________________________ (why/what) Complaint ___________________________________________________________________________ (when) Onset of complaint ______________________________________________________________________ (what) Other conditions _________________________________________________________________________ (what) Allergies _________________________________________________________________________________ (who) Next of kin ________________________________________________________________________________ ADMISSION FORM Nursing and Society Role Transformation of Nurses The healthcare industry has continued to change dramatically over the past few years, transforming the roles and escalating opportunities for nurses. The current shortage of nurses is caused by an increased number of hospitalised patients who are older and more acutely ill, a growing elderly population with multiple chronic health problems, and expanded opportunities for nurses in home care, occupational health, surgical centres, and other primary care settings. Expanding technological advances that can prolong life require more highly skilled personnel. The increasing scope of nursing opportunities will grow immensely as nurses increasingly become the frontline providers of health care. They are assuming important roles in the provision of managed care, and they will be responsible for coordinating and continuing the care outside traditional healthcare facilities. Nurses play a big role in educating the public and addressing the social and economic causes of health issues. Discussion What roles are nurses undertaking in modern society? The Triage Nurse and Monitoring Vital Signs UNIT 3 Learning Objectives Upon completion of the unit, students will be able to: . understand the importance of triage nurses and their professional qualities; . know the methods of measuring body temperature, pulse rate and blood pressure; . have the knowledge of neurological assessment and Glasgow Coma Score (GCS). Starting Off 1 Match the symbols with the meanings. e c d a b 1) First aid equipment here 2) Emergency phone line at all times 3) Fire extinguisher here 4) Emergency exit this way 5) Cardiac defibrillator here MY GLOSSARY defibrillator n. （心脏）除颤器 2 Match the photos with the expressions below. a b c d 1) taking pulse 3) assessing pupil reflex 2) taking temperature 4) measuring blood pressure MY GLOSSARY pupil n. 瞳孔；学生 reflex n. 反射动作；本能反应 Reading 3 Read the text. Are the following sentences true (T) or false (F)? The triage nurse is often the first member of the health team that a patient meets in accident and emergency. Not all patients arriving in A&E require emergency treatment and this can waste healthcare staff’s precious time. The triage nurse’s role is to determine the severity of the symptoms each patient presents and attribute a priority level (associated with a colour) to each patient. In this way, the most serious cases can be treated immediately and less serious cases can wait. Children and the elderly are also given priority. The triage nurse also treats cases where a doctor’s intervention is not required. When necessary, the triage nurse also orders tests to be carried out before the patient sees the doctor. The doctor then has all the information necessary to treat the patient quickly and effectively. T F　　　　 1) Medical staff in A&E only treat emergencies. 　　　　 2) The triage system helps improve efficiency. 　　　　 3) Patients are treated in order of severity only. 　　　　 4) Triage nurses treat some patients. 　　　　 5) Triage nurses carry out tests. 　　　　 MY GLOSSARY triage n. 病人鉴别分类；分诊 severity n. 严重程度 symptom n. 症状，征兆 attribute v. 把……归于 priority n. 优先次序；优先权 intervention n. 干涉，介入 4 Read the text about first aid for burns. Match the titles in the box with the paragraphs. Then decide whether the following sentences are true (T) or false (F). Covering the burn Stopping the burning process Analgesia Cooling the burn 1) _________________ The heat source should be removed. Clothing can retain heat and should be removed from the wound as soon as possible but adherent material, such as nylon clothing, should be left. 2) _________________ Immersion or irrigation with running tepid water (15 °C) should be continued for up to 20 minutes. This also removes noxious agents and reduces pain, and may reduce swelling. 3) _________________ Exposed nerve endings will cause pain. Cooling and simply covering the exposed burn will reduce the pain. Opioids may be required initially to control pain. Later non-steroidal anti- inflammatory drugs such as ibuprofen or co-dydramol taken orally will suffice. 4) _________________ The burn area must be covered. Polyvinyl chloride film (cling film) is an ideal cover. The commercially available roll is sterile if the first few centimetres are discarded. This dressing is pliable, non-adherent, impermeable, acts as a barrier, and is transparent for inspection. It is important not to cover the whole area but the wound only, especially on limbs, as swelling may cause constriction. T F　　　　 1) All materials next to the wound should be removed. 　　　　 2) Water reduces heat, pain and swelling. 　　　　 3) Covering the wound helps to reduce pain. 　　　　 4) Drugs can be taken to reduce pain. 　　　　 5) The burn area should be disinfected. 　　　　 6) Cling film is good because it is transparent and the wound can be examined. 　　　 　 MY GLOSSARY analgesia n. 痛觉缺失 retain v. 保持，保有 adherent adj. 黏性的，黏着的 tepid adj. 温热的，微热的； 不热情的，不热烈 的 noxious adj. 有毒的，有害的 swelling n. 肿胀，肿块 opioid n. 鸦片类药物，阿片 类药物 non-steroidal adj. 非甾类化合物的 anti-inflammatory adj. 消炎的 ibuprofen n. 布洛芬 co-dydramol n. 一种含可待因 的止痛片 suffice v. 足够；满足要求 polyvinyl chloride 聚氯乙烯 sterile adj. 无菌的；不育的 discard v. 抛弃，扔掉 pliable adj. 易弯的，柔韧的 impermeable adj. 不可渗透的；不透气的 transparent adj. 透明的 constriction n. 收缩 5 Read the text about body temperature and insert the headings from the box in the appropriate spaces. Time of day 　 Age 　 Infection 　 Metabolic rate 　 Body temperature 　 Drugs 1) _________________________________ This is a balance between heat production and heat loss. Various physiological and behavioural mechanisms operate to maintain the core body temperature within the range of 36 to 37.6 °C. This process is called thermoregulation and is controlled by the hypothalamus which acts as a thermostat. Body temperature higher than 37 °C is known as pyrexia and body temperature lower than 35 °C is known as hypothermia. 2) _________________________________ The newborn baby’s capacity to regulate temperature is not fully developed as a consequence of a number of factors. A person’s capacity to respond to differences in temperature also decreases in old age. 3) _________________________________ The body’s metabolic processes are a source of heat production. People with an excessive metabolic rate, for example those with an overactive thyroid gland, may have a higher than normal body temperature. Low metabolic rates may cause low body temperatures. 4) _________________________________ Body temperatures normally fall during sleep, so they are the lowest at night and rise during the day, peaking in the early evening. 5) _________________________________ Alcohol diminishes perception of cold and causes vasodilation which causes a lowering of body temperature. Sedatives and narcotic drugs reduce the perception of cold. 6) _________________________________ One of the body’s responses to bacteria or viruses is to raise body temperature above its normal value resulting in increased heat production and inhibition of heat loss. MY GLOSSARY physiological adj. 生理学的 thermoregulation n. 温度调节 hypothalamus n. 下丘脑 thermostat n. 恒温器 pyrexia n. 发热；热病 hypothermia n. 体温过低 metabolic adj. 代谢的，新陈代谢的 thyroid n. 甲状腺 gland n. 腺体 diminish v. 减少，减小，降低 perception n. 观念，看法；感觉 vasodilation n. 血管舒张 sedative n. 镇静剂 narcotic n. 催眠药，麻醉剂；毒品 adj. 致幻的；麻醉的 inhibition n. 抑制；拘束；顾忌 paraventricular nucleus 下丘脑室旁核 ventromedial nucleus 腹内侧核 preoptic nucleus 视前核 anterior nucleus 前核 suprachiasmatic nucleus 视交叉上核 optic nerve 视觉神经 mammillary body 乳头体 optic chiasm 视神经交叉 supraoptic nucleus 视上核 pituitary gland 脑下垂体 6 Read these descriptions. Match the thermometer types with the illustrations. a b c d 1) Mercury in glass thermometers These can be used in the mouth, the axilla and the rectum. They are inexpensive and widely available. Accuracy is dependent on correct technique, for example leaving the thermometer in situ for the correct amount of time. The use of mercury in glass thermometer has gone down recently with the advent of methods that are seen as safer and more hygienic than those involving mercury. 2) Disposable thermometers These are thin plastic strips that have 50 small areas of thermosensitive chemicals that rapidly change colour with increasing temperature and are used in the mouth or axilla. They are relatively inexpensive. They are disposable so there is no risk of cross infection. 3) Electronic thermometers These consist of a probe which is placed in the mouth, the axilla or the rectum (sometimes connected to a power supply and display unit). They are accurate. New probe covers are needed for each use so they are expensive. 4) Infrared light reflecting thermometers These detect heat radiated as infrared energy from the tympanic membrane. The temperature registers in a few seconds. The use of disposable probe covers prevents cross infection but increases the cost. MY GLOSSARY mercury n. 水银，汞 thermometer n. 温度计，体温计 axilla n. 腋窝，腋下 rectum n. 直肠 accuracy n. 准确，精确，正确 in situ 在原地，就地 disposable adj. 一次性的；用后可扔 掉的 thermosensitive adj. 热敏的 infrared adj. 红外线的 tympanic adj. 鼓膜的 membrane n. 膜状物；膜 7 Read the descriptions in Exercise 6 again and complete the table below. Type of Thermometer Place for Use Advantages Disadvantages 8 Label the diagram with the correct words or phrases. 1) 9) a temporal b brachial c femoral d facial e radial f popliteal g carotid h posterior tibial i dorsalis pedis 2) 3) MY GLOSSARY 4) temporal adj. 太阳穴的，颞骨的 brachial adj. 臂的，肱的 femoral adj. 股的，股骨的 radial adj. 桡骨的；辐射状的 popliteal adj. 膝后的 carotid adj. 颈动脉的 posterior tibial 胫后肌 dorsalis pedis 足背动脉 5) 6) 7) 8) 9 Read the text about blood pressure and the diagram of heart anatomy. Answer the questions beside the diagram. Blood pressure can be measured in two ways: electronically, for example by means of a doppler, or manually by the use of a mercury sphygmomanometer. There are two values measured, systolic and diastolic pressure. Systolic occurs during ventricular contraction and diastolic occurs after the aortic valve closes. When recorded, systolic appears above and diastolic below (e.g. 120/75 is systolic pressure=120, diastolic pressure=75). Abnormally high blood pressure is known as hypertension. Low blood pressure is called hypotension. 1) What is hypotension? 2) What is a sphygmomanometer? 3) What is a doppler? 4) What is systolic blood pressure? 5) What does 140/90 mean? 6) What is hypertension? MY GLOSSARY doppler n. 多普勒 (一种超 声波检测仪器) sphygmomanometer n. 血压计 systolic adj. 心脏收缩的 diastolic adj. 心脏舒张的 ventricular adj. 心室的 aortic adj. 大动脉的 hypertension n. 高血压 hypotension n. 低血压 aorta n. 大动脉 pulmonary adj. 肺的 vena cava 腔静脉 atrium n. 心房 tricuspid valve 三尖瓣 mitral valve 二尖瓣 septum n. 间隔 ventricle n. 心室 10 Read the introduction to neurological assessment. Match the synonyms with words in green in the text. movement evaluation black central part of the eye signal physical damage This comprises the (1) assessment of the level of consciousness, (2) pupil reaction, (3) motor and sensory functions and vital (4) signs. This helps in making decisions regarding treatment, diagnosis and prognosis of the patient. In some situations, particularly head (5) injury, this is extremely important as life-saving treatment could be necessary. The Glasgow Coma Score (GCS) is widely used in neurological assessment. It was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, nurses and doctors with acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care. The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow’s Institute of Neurological Sciences at the city’s Southern General Hospital. MY GLOSSARY sensory adj. 感觉的，感知的 diagnosis n. 诊断 prognosis n. 预断；展望 neurological adj. 神经系统的 initially adv. 最初，开头 acute adj. 急性的；严 重的 trauma n. 创伤；外伤 11 Read the definitions and do the crossword using words or phrases from this unit. Across 2) a hospital system where colours represent level of urgency (6, 6, 6) 5) serious condition related to blood flow to the heart (6) 7) level of importance (8) 10) a minor condition also known as gastric reflux (9) Down 1) transparent material used to cover burns (5, 4) 3) inspect (7) 4) to reduce heat (4) 6) the deepest part of the skin 8) the opposite of life (5) 9) opposite of best (5) 1) 4) 3) 2) 6) 5) 7) 8) 9) 10) MY GLOSSARY gastric adj. 胃部的 reflux n. 反流 Listening 12 Listen and complete the text about triage colour-coding. The triage system involves a colour-coding system using red, yellow, green and black tags: . (1) ______________ tags patients who require (2) ________________ treatment for a (3) ________________ condition. . (4) ______________ tags the condition is (5) _________________ for the moment, the patient is not in immediate danger of (6) _________________ but requires treatment. . (7) _____________ tags medical care is needed at some point after more (8) _________________ have been treated. . (9) _____________ tags used for those who need (10) _________________ medication only before (11) _________________. 13 Listen to the dialogue between a triage nurse and a patient and complete the text. Then answer the questions below. Nurse: Good evening, Sir. Can I have your name please? Patient: Hardy. (1) _________________ Hardy. Nurse: Could you spell your first name please? Patient: (2) _________________. Nurse: And your date of birth? Patient: 24th (3) _________________. Nurse: And what seems to be the (4) _________________ Mr Hardy? Patient: I have a pain. A terrible pain. Nurse: Can you tell me where the pain is? Patient: All over. It’s awful. And I’ve been waiting here for 20 minutes already. I’ve already had two (5) _________________. Nurse: Can you be (6) _________________ about the pain? Patient: It’s in my (7) _________________ and chest. The coffee here is terrible by the way. Nurse: Now, how bad is the pain on a scale from 0 to 10? 0 is no pain and 10 is the worst pain you can imagine? Patient: 10 of course. I’ve come to hospital. Nurse: And when did the pain start? Patient: Well about (8) _________________ ago. Every time I go out for (9) _________________ I have the same problem. Nurse: Have you ever had chest pain at other times, running or going up stairs? Patient: No, only when I eat. Nurse: Have you been to your GP about the problem? Patient: No, not yet. It always happens at the (10) _________________. Nurse: Did you go out for dinner (11) _________________? Patient: Yes. Great meal. All you can eat for ￡10.00. Nurse: Oh. It’s probably some form of (12) _________________. Can you please take a seat? A nurse will (13) _________________ you as soon as possible but as you can see we are very busy tonight so you will probably have to wait. Patient: But I’ve already waited 20 minutes! I can’t stay here all night. I want to see a doctor (14) _________________! Nurse: I’m afraid that isn’t possible Mr Hardy. There are patients who need to be seen (15) _________________. Could you please take a seat? Patient: I’m going (16) _________________! Shocking service here! I’ll go to my doctor on Monday! 1) Why do you think the man has chest pain? 2) Why hasn’t he seen his GP? 3) How does the nurse decide that it is not urgent? 4) Why does the nurse tell him to take a seat? 5) Why doesn’t the nurse tell him to go home? 6) Why does the patient go home? 7) Which adjectives best describe the nurse? Underline them. polite rude collaborative non-collaborative angry calm patient impatient 8) Which adjectives best describe the patient? Underline them. polite rude collaborative non-collaborative angry calm patient impatient 14 Listen and complete the text about heartburn and angina pectoris. Look at the pictures to help you. Heartburn, or (1) _________________ reflux, is a condition in which a person experiences a burning sensation or pain (2) _________________, but it is not related to the (3) _________________. This burning sensation is caused by acid reflux (when the stomach’s (4) _________________ flows up and comes into (5) _________________ with the walls of the oesophagus). Angina pectoris is a (6) _________________ that is also characterised by pain in the chest. Angina happens when the (7) _________________ flow to a certain part of the heart is decreased due to a build up of plaque. Heartburn and angina are completely (8) _________________ conditions. However, many people confuse angina and heartburn because the (9) _________________ seem (10) _________________. It is very important to see a (11) _________________ who can distinguish between the two conditions. MY GLOSSARY oesophagus n. 食管，食道 sphincter n. 括约肌 heartburn n. 胃灼热，烧心 angina pectoris 心绞痛 plaque n. 斑块 15 Choose the correct option according to the text above. 1) Heartburn is _________________. A similar to angina B related to the stomach C related to a chest problem 2) Heartburn has _________________. A some similar symptoms to angina B the same cause as angina C different symptoms from angina 3) Angina is _________________. A a cardiac problem B a gastrointestinal problem C a minor problem 4) The burning sensation in heartburn is related to _________________. A sensitivity of the stomach B sensitivity of the oesophagus C a decrease in blood flow to the heart 16 Listen and complete the text about the pulse. The pulse represents each (1) _______________ contraction of the (2) _______________ in a healthy person. It is the number of beats in a (3) ________________ second period. A person’s pulse rate varies depending on (4) ________________, disease, (5) ________________ and trauma. A pulse can be measured when an (6) ________________ near the surface of the body is pressed against a solid surface such as bone. The pressure applied to the (7) ________________ when feeling for a pulse is called (8) ________________. There are three factors to be considered: the (9) ________________ (how many beats per minute?), the (10) ________________ (is the beat strong or weak?) and the rhythm (is it regular or irregular?). It is important that the patient is (11) ________________ because stress will (12) ________________ the pulse rate, giving a false measurement. The pulse can be measured in different places in the body depending on the patient’s condition. 17 Listen and complete the Glasgow Coma Score (GCS) table. Behaviour Response Score Eye (1) ____________ response Spontaneous To speech To (2) ____________ No response 4 3 2 1 Best (3) ____________ response Relevant to (4) ____________, place and (5) ____________ Confused (6) ____________ words Incomprehensible sounds No response 5 4 3 2 1 Best (7) ____________ response Obeys (8) ____________ Withdraws at localised pain Flexion withdrawal from pain (9) ____________ flexion Abnormal extension No response 6 5 4 3 2 1 Total score Total score analysis Best response—15 Comatose patient—(10) ____________ or less Totally unresponsive—3 MY GLOSSARY spontaneous adj. 自发的，非筹划安 排的 incomprehensible adj. 不能理解的，极难 懂的 withdraw v. 撤回，取回； 退出 flexion n. （关节、肢的）屈曲 comatose adj. 不省人事的，昏迷的 18 Let’s see what you remember about the pulse, blood pressure and neurological assessment. Are the following sentences true (T) or false (F)? Correct the false information. T F　　　　 1) The pulse rate is the number of heart beats per minute. 　　　　 2) The pulse is measured by touching the vein. 　　　　 3) The best place to measure the pulse is always the arm (radial pulse). 　　　　 4) Anxiety can affect the pulse rate. 　　　　 5) Systolic blood pressure occurs after the aorta valve closes. 　　　　 6) There are two blood pressure values necessary. 　　　　 7) Hypotension is high blood pressure. 　　　　 8) Neurological assessment involves different parts of the body. 　　　　 9) A rapid assessment is helpful in head injuries. 　　　　 10) Patients with a GCS of 5 are classified comatose. 　　　　 Speaking 19 Work with a partner. Make similar dialogues to the one in Exercise 13. Take turns to be the nurse and the patient. Use the dialogue to help you. Writing 20 Look at the picture and complete the text about skin burns. First degree burns are limited to the (1) _________________. (2) _________________ degree (3) _________________ extend into the (4) _________________. Third (5) _________________ (6) _________________ extend through the (7) _________________ and into the (8) _________________. MY GLOSSARY epidermis n. 上皮，表皮 dermis n. 真皮（位于表皮下方，包括 血管、汗腺和神经末梢） hypodermis n. 下皮组织 Nursing and Society Qualities of Triage Nurses . A high moral quality Moral quality is the core one of all other qualities for this position. Triage nurses are required to understand and respect patients first. . A good psychological quality The psychological quality of triage nurses includes cognitive ability, thinking and response ability, attention, memory, resilience, character and so on. With a good psychological quality, triage nurses are able to deal with patients with various personalities in the outpatient department, eliminate patients’ anxiousness and distress. At the same time, the nurses are required not to bring personal unhappiness to work. Smiling and treating patients in a natural and generous manner could shorten the emotional distance between nurses and patients. . An excellent service quality Outpatient triage is characterised by many subjects and diseases, and it is difficult to be competent without multidisciplinary knowledge. This position requires nurses to constantly learn new knowledge. Beyond the professional knowledge, psychology, behavioural medicine and social medicine are needed necessarily. . Proper communication skills The triage nurses ought to receive patients with smile. The language the nurses use when talking with patients should be kind and gentle, which will bring patients a sense of pleasure. Discussion As a triage nurse, what other qualities do you think are essential? Unit 3 The Triage Nurse and Monitoring Vital Signs 41 Preventing Cross Infection UNIT 4 Learning Objectives Upon completion of the unit, students will be able to: . master the definition of cross infection; . understand the chain of infection; . know measures to prevent cross infection; . compare cross infection and secondary infection. Starting Off 1 Can you find the connection between the photos? Write the word in the space below. They can cause infection: 2 Match the words with their synonyms. 1) place a portal 2) illness b duty 3) origin c source 4) door d site 5) obligation e disease Reading 3 Read and listen to this description of cross infection. What type of infection is shown in the photos on this page? Many microorganisms exist but not all cause infection in individuals. Those that cause disease are called pathogens. When microorganisms, colonising one site on the patient, enter another site on the same person and cause more infection, this is called self-infection or endogenous infection, for example an infection on the hand that is passed to the eye. When pathogens are acquired from another person, or from outside, they are called exogenous. The transmission of pathogens, between people and across environments, is termed cross infection. To prevent cross infection we must break the chain of infection. The chain consists of the source of infection, the route of transmission, the portal of entry and the incubation period before infection. There is an ethical and legal duty to protect patients against infection. Universal precautions are recommended for all patients because it is impossible to know if a patient is a hepatitis B carrier or is HIV seropositive, so every patient is considered a potential hazard and appropriate methods should be used to prevent contamination by blood or body fluids. This protects the nurse from infection with body-fluid borne viruses but also protects the patients from cross infection. In hospital situations, the risk of cross infection is high. Hospital acquired infection, sometimes referred to as nosocomial infection, is a big problem and, without the adequate precautions, nursing staff may transmit microorganisms from one patient to another. MY GLOSSARY microorganism n. 微生物 infection n. 感染，传染 pathogen n. 病原体，病菌 colonise v. 在……大量繁殖；使殖 民地化 endogenous adj. 内生的，内源的 exogenous adj. 外生的，外源的 transmission n. 传播；播送 consist of 由……组成 incubation n. 潜伏；孵化 ethical adj. 道德的，伦理的 universal adj. 普遍的，全 体的，共同 的 precaution n. 预防；预防措施 hepatitis n. 肝炎 seropositive adj. 血清反应阳性的 hazard n. 危险物，危害物 v. 大胆猜测；冒……的危 险 contamination n. 污染；污染物 nosocomial adj. 医院的 adequate adj. 足够的，充分的 4 Read the text again. Are the following sentences true (T) or false (F)? T F　　　　 1) All microorganisms cause disease. 　　　　 2) A pathogen is a microorganism that causes infection or disease. 　　　　 3) With self-infection, the microorganisms come from the environment. 　　　　 4) Exogenous pathogens come from the environment. 　　　　 5) Preventing cross infection is a professional obligation. 　　　　 6) There are guidelines to help prevent cross infection. 　　　　 7) The universal precautions are used with high-risk patients only. 　　　　 8) Nurses can be a route of transmission for pathogens. 　　　　 5 Label the parts of the hand. 1) back or dorsum 2) palm 3) finger 4) fingertip 5) index finger 6) middle finger 7) ring finger 8) thumb 9) finger nail 10) wrist a d c e b f h j g i 6 Label the pictures with the words or phrases from the box. waste sack bottle of bleach mask sharps bin apron paper towel latex gloves goggles / protective glasses 1) ____________________ 2) ____________________ 3) ____________________ 4) ____________________ 5) ____________________ 6) ____________________ 7) ____________________ 8) ____________________ 7 Read the text and complete the chart. The key difference between cross infection and secondary infection is that cross infection refers to the transfer of harmful microorganisms from another person, medical equipment or tool while secondary infection is an infection that occurs during or after treatment for another infection. Infections can be prevented via maintaining clean and thoroughly sanitised areas around patients. Hence, doctors wash their hands frequently. Moreover, sterile environments are maintained inside the hospitals. Cross infection and secondary infection are two types of infections from which patients should be saved. Cross infections can be caused due to different factors. Some of these include unsterilised medical equipment, coughing and sneezing, human contact, touching contaminated objects, dirty bedding, and prolonged use of catheters, tubes or intravenous lines. Cross infections can be detected by blood tests, urine tests, culture test, X rays, etc. Secondary infection can be caused by the first treatment, changes in the immune system, or antibiotic resistance of pathogens. Generally, secondary infections are responsible for prolonging the first infection, making it more severe. MY GLOSSARY sanitise v. 给……消毒；对……进 行卫生处理；使清洁 catheter n. 导管 intravenous adj. 静脉内的；静脉的 antibiotic resistance 抗生素耐 药性 severe adj. 严重的；严厉的 Cross Infection VS Secondary Infection . Cross Infection: ____________________ _______________________________________ . Secondary Infection: ________________ _______________________________________ Definition . Cross Infection: ____________________ _______________________________________ . Secondary Infection: ________________ _______________________________________ Causes Listening 8 Listen and complete the text about Ignaz Semmelweis. Semmelweis was a Hungarian (1) _________________ born in (2) _____________. He succeeded in reducing the (3) _____________ rate of his patients from around (4) ______________ in (5) _____________ to (6) _____________ in (7) ____________. He simply convinced his colleagues and the medical (8) _____________ he worked with, to (9) ________________ their hands in a solution of (10) _____________ lime. It is now widely recognised that the (11) _____________ of people who work in health care are an important (12) _____________ for the transmission of (13) _____________. Consequently, handwashing is considered the most important basic technique for (14) _____________ the transmission of (15) _____________. 9 Look at the pictures and listen to complete the handwashing guide. Use an adequate amount of handwashing solution. 1) Put your _____________ together. Rub _____________ against _____________. 2) Put your right palm over your left _____________ and rub. 3) Put your _____________ palm over your right dorsum and rub. 4) Put your palms together with _____________ interlaced and rub. 5) Rub the fingers of your _____________ hand across your left palm. 6) Rub the fingers of your left hand across your _____________ hand. 7) Rotationally rub the _____________ clasped over the _____________ palm and vice versa. 8) Rotationally rub the _____________ of your left hand in your _____________ palm and vice versa. 9) Rub the fingertips of your right hand in your left palm and vice versa. 10 Listen and complete the Universal Precautions. Handwashing is essential before and after all (1) _____________ (2) _____________ and after skin contamination with body fluid. (3) _____________ and aprons must be used when (4) _____________ contact with (5) _____________ or body fluid is anticipated. Eye protection (such as protective goggles or glasses) (6) _____________ be used if there is a danger of flying contaminated debris or blood splashes. Irrigate with (7) _____________ solution if conjunctiva or mucous membranes are splashed with body fluid or blood. Cuts and (8) _____________ should be covered with waterproof dressings. Be extremely careful when using and disposing of (9) _____________ and do not overfill sharps boxes. Action in the event of blood spillage: . Put on (10) _____________ and apron. . Cover the blood spillage with (11) _____________ towels. . Treat with the 10,000 ppm sodium hydrochloride or bleach 1 to 10 dilution. . Leave for a few (12) _____________. . Clean up and dispose of as (13) _____________ waste. . Contaminated waste is disposed of in (14) _____________ clinical waste sacks. 11 Answer these questions according to what you have learned in this unit. Then listen and check your answers. 1) All microorganisms cause infection—true or false? 2) What do we call the transmission of pathogens between people? 3) Endogenous infection is self infection—true or false? 4) What nationality was Dr. Semmelweis? 5) What type of doctor was Dr. Semmelweis? 6) Name two parts of the hand that often are not clean after handwashing? 7) Clinical waste is disposed of in black sacks—true or false? 8) What is the joint that connects the hand to the arm? 9) What is nosocomial infection? 10) Nurses should be careful only when working with high-risk patients—true or false? Speaking 12 Which areas do you think are often dirty after handwashing? 13 Student A reads out the instructions in Exercise 9. Student B acts out the handwashing instructions. Take turns. Writing 14 Describe the infection process by selecting the right expressions and filling in the blanks. Then write a short article, starting with “After a pathogen invades into the body of a person, …” A ________________________________________________________________________________________________ B ________________________________________________________________________________________________ C ________________________________________________________________________________________________ D ________________________________________________________________________________________________ E ________________________________________________________________________________________________ 1) The person may become a chronic carrier of the infectious agent. 2) Illness period (clinical signs and symptoms) 3) Incubation period (pathogen replicates in host) 4) Prodromal period (early signs and symptoms, e.g. fever, fatigue) 5) Convalescent period (signs and symptoms recede; person returns to health) A B C D E Nursing and Society China Issues Guidelines on Patriotic Public Health Campaign China’s State Council has issued a set of guidelines on carrying out the patriotic public health campaign in a deep-going way, with the aim of laying solid foundations for building a healthy China. The document calls for efforts to strengthen the application of big data, effectively prevent and control infectious and chronic diseases, and improve people’s health, so as to lay solid foundations for building a healthy China. It underscores improvements to public health facilities and the living environment in both urban and rural areas. More work should be done to step up sewage and garbage treatment, advance the “toilet revolution” to improve sanitation of toilets, ensure drinking water safety and strengthen vector control, it says. Health knowledge should be promoted among the public, says the document, which also advocates a healthy and environmentally-friendly lifestyle. It also stressed innovation to improve management, strengthening the rule of law in carrying out relevant work and intensifying policy research and technical support. Discussion In which fields are the public hygiene efforts made? Assisting the Patients UNIT 5 Learning Objectives Upon completion of the unit, students will be able to: . know the definitions of urination, urinary incontinence aids and urinalysis; . describe the process of managing urinary incontinence; . label toiletries and hygiene equipment; . understand different kinds of personal hygiene demands. Section 1 Assisting with Elimination Starting Off 1 1 Incontinence can affect both men and women in any age group. Can you describe incontinence in your own words? What problems does incontinence bring to people suffering from it? 2 Match the aids for urinary elimination/incontinence in the pictures with the words or phrases. 1) toilet 2) commode 3) urinary catheter 4) bed pan 5) incontinence pant c a d e b Reading 1 3 Complete the text with the words from the box. Then listen and check your answers. voluntary seven neurological elderly bladder urethra neurologically process prostate Urination is the release of urine from the (1) ________________ through the (2) ________________ to the urinary meatus outside the body. It is also known medically as micturition, voiding or uresis, and known colloquially by various names including passing water, weeing or peeing (childish) and pissing (vulgar). In healthy humans the (3) _________________ of urination is under (4) _________________ control. In infants, some (5) _________________ individuals, and those with (6) _________________ injury or enlarged (7) _________________, urination may be involuntary (incontinence). It is normal for adult humans to urinate up to (8) _________________ times during the day. Physiologically, urination is a (9) _________________ controlled function. 4 Complete the chart using the information in Exercise 3. Medical Terms Informal Terms Organs / Body System Patients with High Risk of Incontinence urination passing water urinary meatus infants 5 Look at the diagram of the bladder and complete the phrases. Then listen and check your answers. 1) When the _________________ muscle relaxes, the _________________ fills. 2) The pelvic floor muscles and the urethral sphincter _________________ to hold the urine. 3) When the detrusor muscle ____________ and the ____________________ muscles relax, urine is released from the ___________________. MY GLOSSARY bladder n. 膀胱 urethra n. 尿道 prostate n. 前列腺 urination n. 排尿 meatus n. （身体部分，尤指通向 体外的）道，口 micturition n. 排尿 void v. 排泄 uresis n. 排尿 colloquially adv. 口语地，通俗语地 vulgar adj. 粗俗的，不雅的 involuntary adj. 无意识的；非自愿的 6 Label the diagram with the words or phrases. 1) collection bag 2) bladder 3) urinary meatus 4) catheter 5) catheter tube 6) sample port/tap 7) drainage tap 7 Read the text and answer the questions. A urinalysis is a simple and non-invasive procedure which provides important information about the health and well-being of a person. A nursing assessment of a newly admitted hospital patient must always include a urinalysis. People who have a kidney condition, or people with a condition which must be monitored also require regular urinalysis. This group includes pregnant women and people at increased risk of UTI. In non-catheterised patients, a mid-stream specimen is preferred as it will not be contaminated by bacteria outside the urinary tract. In catheterised patients, the urine sample must be taken from the sample port/tap and not from the catheter bag where there is a greater risk of bacteria infected urine. 1) What are the advantages of urine analysis? 2) Who should have a urine analysis? (4 groups) 3) Why is a mid-stream urine sample best? 4) Why must the specimen NOT be taken from the catheter bag? a _________________ b _________________ c _________________ d _________________ e _________________ f _________________ g _________________ MY GLOSSARY urinalysis n. 尿液分析 invasive adj. 侵袭的，侵入的 assessment n. 评估，估价 pregnant adj. 怀孕的 catheterise v. 插入导管 contaminate v. 污染，弄脏 urinary tract 尿道，尿路 Listening 1 8 Listen and complete the text about managing urinary incontinence with the words and phrases from the box. comfortable skin frequently hygiene cream short cross infection urethra empty bag gloves leg bed bacteria emptying neurological Urinary incontinence aids should be hygienic, (1) _________________ and preserve the patient’s dignity. Super-absorbent pads/pants can be used but must be changed (2) _________________ to avoid (3) _________________ irritation. If the skin is very sensitive, a barrier (4) _________________ may be necessary. It is also important to observe correct (5) _________________ practices when changing pads or cleaning the area to prevent (6) _________________. Because it often causes urinary tract infections (UTI), catheterisation should be used only when necessary and for as (7) _________________ a period as possible. In patients with degenerative (8) _________________ disease or chronic incontinence, permanent catheterisation will become necessary. In catheterisation, the catheter tube is passed through the (9) _________________ into the bladder. The tube is attached to a urinary collection (10) _________________ which has a small tap to (11) _________________ the bag. The bag may be attached to the incontinent patient’s (12) _________________, or attached to the hospital (13) _________________. Hygiene is extremely important as the catheter bag and tube can harbour (14) _________________ and infection. (15) _________________ must always be worn when changing or (16) _________________. MY GLOSSARY dignity n. 尊重；庄重 absorbent adj. 能吸收的 irritation n. 发炎；疼痛 sensitive adj. 敏感的；娇嫩的 catheterisation n. 导管插入术 chronic adj. 慢性的，长 期的 permanent adj. 永久性的 harbour v. 携带（细菌等）；怀有 （想法或感情） 9 Put the instructions into the correct order. Then listen and check your answers. Immerse all areas of the strip in fresh urine and remove any excess urine on the edge of the container. Put on sterile gloves. Observe urine for colour, consistency and smell. Compare the coloured areas of the strip with the corresponding chart on the bottle. Open the urine container carefully. Hold the strip horizontally to prevent mixing of the wet chemicals on the strip. Speaking 1 10 Discuss what would be appropriate in these situations. Look at the photos in Exercise 2 and complete the table. . Mrs Mattias is in Intensive Care attached to a ventilator. . James is a 14 year-old male who has broken both legs. . Mr Harris is 48 and has multiple sclerosis. He is mobile but is becoming incontinent. . Mrs Papalaou is 94. She lives in a residential care home. She is in bed with flu and is very weak at the moment. . Mr Shepherd is 83. He lives at home and is mobile and continent but suffers from arthritis. Name Situation Factors to Consider Appropriate Method Mrs Mattias hospital / attached to ventilator not conscious, cannot move catheterisation Section 2 Assisting with Personal Hygiene Starting Off 2 11 Personal hygiene practices are important for maintaining good health and a favourable appearance. The best practices are generally related to cleanliness. Work with your partner to talk about your habit in the following practices: . bathing and showering . washing the hands regularly . caring for the teeth (brushing and flossing) . wearing deodorant . laundering the clothing after wearing . keeping the hair groomed 12 Work with a partner to match the objects with the pictures. How often do you use these objects? Every day? Three times a week? Once a month? Rarely? Never? 1) deodorant 2) sponge 3) toothpaste and toothbrush 4) shampoo 5) soap 6) basin 7) brush and comb 8) hairdryer 9) mirror 10) nail-clipper/cutter 11) tampons and sanitary pads 12) make-up 13) razor a b c d h f g e i l m j k Reading 2 13 Find words in the text and match them with their definitions or synonyms below. Assisting patients with personal hygiene is a fundamental part of nursing. It contributes to the patient’s comfort and gives patients a sense of well- being and self-esteem. Personal hygiene is one of the activities which most people perform for themselves, so patients may feel embarrassed. Some patients need temporary assistance, for example during a hospital stay. Other patients who have a physical or mental disability need assistance on a permanent basis. Bathing is necessary to avoid infection and keep the patient healthy. Bathing may be in the bathroom or, if the patient is not mobile, in bed using a bed-bath. 1) very important ___________________ 2) helping ___________________ 3) for a short period of time ___________________ 4) always ___________________ 5) a good opinion of oneself ___________________ 6) health ___________________ 14 Read the text about bed-baths. Put these instructions in the spaces below. Then listen and check your answers. . Remove any lower body clothing. . Apply moisturising cream if the skin of the legs appears dry. . You may need to change the bed linen if it has become wet. . Can the patient wash his or her face alone? . Fill a basin with warm water. . Uncover the chest and abdomen and wash and dry in the same way. Once you have completed this, apply deodorant or body spray if desired. Bathing a patient in bed: 1) Wash your hands and put on a plastic apron and gloves if necessary. 2) ________________________________________________________________________________________________ 3) Remove the top covers and the pyjama jacket or nightdress leaving the body covered by a towel. 4) ________________________________________________________________________________________________ 5) If it is not possible, wash the patient’s face. Take care to wash from the inside to outside corners of the eye thus reducing the risk of contamination. Dry the face carefully. People who are unconscious are at risk of corneal damage and eye infections. So they require particular eye care to prevent problems. 6) Place a towel under the patient’s arm and wash from the hand up to the axilla with soap and water. Rinse off the soap and dry thoroughly. 7) ________________________________________________________________________________________________ 8) Empty the basin and change the water at this point. 9) ________________________________________________________________________________________________ 10) Cover the leg nearest to you and place a towel under the opposite leg, wash the leg from toes up to groin, rinse and dry. Repeat with the other leg. 11) ________________________________________________________________________________________________ 12) Ask the patient to lean forward. 13) Wash, rinse and dry the patient’s back using a clean washcloth. 14) Change the patient’s pyjamas or nightdress. 15) ________________________________________________________________________________________________ 15 Read the text and match the headings in the box with the paragraphs. Dentures Treatments Disability Medication Healthy oral mucosa, teeth and gums are important to general health and self-esteem. Many people need assistance with dental hygiene. Poor oral hygiene can cause many problems such as candidiasis (a fungal infection), malnutrition caused by lack of appetite, halitosis (bad breath), and social problems as a result, and a spread of infection in immunocompromised patients (with low defences). There are many factors that lead to poor oral hygiene. 1) _____________ People who cannot move their hands properly or who have coordination difficulty will be unable to brush their teeth effectively. 2) _____________ Certain types of drugs reduce the level of saliva in the mouth. 3) _____________ If they do not fit the mouth properly, this can cause irritation and infection in addition to making eating painful. Dentures should be changed every 4 or 5 years as the gingiva changes over time. Dentures that are not cleaned effectively are a source of bacteria and infection. 4) _____________ Radiotherapy of the head or neck or restricted intake (no food orally) postoperatively cause dry mouth. 16 Complete the sentences with words from this unit. 1) My face is very _____________. I need some moisturising cream. 2) I want to shave, but I don’t have a(n) _____________. 3) Nurse, can you give me some _____________, please? My nails are too long. 4) Don’t worry, Ms Jones. If your period starts we have _____________ in the ward. 5) I have some toothpaste in my bag, but I forgot my _____________. 6) I need a(n) _____________ to dry my hands. 7) You should _____________ your teeth after eating. 8) I want to check my make-up. Do you have a(n) _____________? MY GLOSSARY mucosa n. 黏膜 candidiasis n. 念珠菌病 fungal adj. 真菌引起的 halitosis n. （呼出的）臭气，口臭 immunocompromised adj. 免疫功能 受损的，免疫力低下的 denture n. 假牙 radiotherapy n. 放射疗法 postoperatively adv. 术后地 Listening 2 17 Listen and complete the notes about bathing a patient. Bathing a patient in a bath: . Fill the bath with warm water using your elbow or a thermometer to (1) _____________ the temperature. . Assist the patient to the bathroom. . Ask if the patient needs to use the (2) _____________. Warm water can stimulate the need to (3) _____________ or relax bowel muscles. . Help the patient to undress but keep the patient warm and maintain dignity by using towels to cover (4) _____________ areas. . If the patient has a urinary (5) _____________, a shower is preferable. If a shower is not possible, the catheter must be clamped when moving the patient in and (6) _____________ of the bath. This stops urine re-entering the bladder when the catheter is raised above bladder level. . Let the patient test the temperature. Remember, patients with reduced peripheral (7) _____________ function, such as (8) _____________ patients, may not feel heat and there is a risk of burning. . Always pay particular attention to folds of skin, such as under the (9) _____________, axilla, between the buttocks, around the (10) _____________ and between the toes. These areas must be washed and (11) _____________ carefully. . Dry the upper body and empty the bath (12) _____________ helping the patient out. . The patient may need an emollient cream to protect the skin and prevent (13) _____________. . Remember, the patient must (14) _____________ be left (15) _____________ in the bathroom during bathing. . If the patient is not mobile, a bath hoist is necessary. Speaking 2 18 Look at the pictures in Exercise 12 again. What would you use to…? Use the expression “I would use…to…” to complete the sentences. Then listen and check your answers. 1) …brush/comb your hair? 2) …avoid body odour? 3) …wash your body? (2 objects) 4) …wash your hair? 5) …clean your teeth and mouth? 6) …shave? 7) … absorb blood flow during your menstrual cycle / period? 8) …cut your nails? 9) …look good and feel better? 10) …dry your hair? 11) …look at your face? 12) …put water in? 19 Look at the photos and discuss. What problems can edentulism (no teeth) cause? 20 Read about four patients. Match them with the photos. What personal hygiene assistance do you think these people need? Discuss with your partner. 1) Carlos is 15. He has a learning disability. He has assistance 24 hours a day. 2) Elisabeth is 54. She has multiple sclerosis. She is incontinent and is not mobile but can use her hands. Her eye-sight is not good. 3) Mrs Mackie is 84. She lives alone and is mobile. She has rheumatoid arthritis which has affected her hands very badly. 4) Joseph is 36. He is in hospital. He has had an operation to reconstruct his leg and is heavily sedated. a b c d Writing 21 Complete the table with these opposite words and phrases from the box and make sentences with them. covered same to uncover dry to remove to fill to dry lower exposed covered upper to wet to apply to empty to cover wet different Nursing and Society Homes for Elderly Face Nurse Shortage In a nation that traditionally sees an elderly person’s family as the primary care giver, commercial nursing homes for the elderly in China are in their infancy and face problems. At one such home in Shijiazhuang, Hebei province, it’s common to see managers join nurses in helping elderly residents move and bathe. Established in 2013, Zhongqiao Nursing Home has 260 beds but only 20 nurses. While China is ramping up elderly-care services, there are not enough nurses to handle the growing number of older people. A longer life expectancy has left China with a demographic challenge: a quickly growing elderly population. There were more than 200 million people over 60 years old last year, accounting for more than 16 percent of the population. The number over age 65 stands at 144 million. To tackle the talent shortage, the Ministry of Education and eight other government departments issued a joint circular in July 2014, encouraging colleges to set up majors related to elderly care, including elderly health and nutrition, psychology of aging, geriatric nursing and bioethics. However, few graduates actually choose jobs related to the major. Discussion What causes the shortage of nurses in nursing homes for elderly residents in China? UNIT Diet and Nutrition 6 Learning Objectives Upon completion of the unit, students will be able to: . identify the link between good health and food intake; . understand the needs of patients regarding nutrition; . give healthy diet advice. Starting Off 1 What foods can you see in the plate? Label the food groups in the plate with the words or phrases. 1) sugars 2) fats 3) water, vitamins and minerals 4) proteins 5) carbohydrates and fibre 2 Write examples under each food group in the table. a b d e c Carbohydrates Fibre Vitamins and Minerals Protein Fats Water rice lentils bananas chicken cheese lettuce Reading 3 Read the text about a healthy diet and insert headings below in spaces A–H. Then listen to the text and complete the gaps. Maintain an adequate calcium intake. Make sure to include green, orange and yellow fruits and vegetables. Limit your fat intake. Avoid too much sugar. Limit your sodium intake. Keep your cholesterol under 300 mg per day. Eat foods rich in complex carbohydrates. If you drink alcohol, do so in moderation. A _________________________ Fats should supply less than (1) _______ of your total daily calories. Choose lean meats, such as (2) _______, fish and low-fat dairy products. Avoid fatty foods. Remember excessive fat intake, particularly saturated fats found in animal products, is related to (3) _______ and heart disease. B _________________________ Cholesterol is found in animal products such as meats, dairy products like milk and cheese and (4) _______. C _________________________ This should be around 55% of your daily calories. Eat legumes, such as (5) _______ and peas, greens fruits and vegetables. This will also help you obtain the 20 or (6) _______ of fibre you need each day as well as provide important (7) _______ and minerals. D _________________________ (broccoli, carrots, peppers and citrus fruits) These foods contain antioxidants which help protect against certain types of cancer and other diseases. Vitamin C which is found in (8) _______ lemons and mandarins, prevents scurvy. Folic acid, which is found in green leaf vegetables such as spinach, can prevent (9) _______. Vitamin K is a clotting agent and the (10) _______ of vitamin K can lead to spontaneous haemorrhaging. Maintain a moderate protein intake. Protein should make up around (11) _______ of your calories. E _________________________ Too much salt in your diet causes high (12) _______ pressure. Sodium is found in many processed foods. F _________________________ This is essential for strong (13) _______ and teeth. Low levels of calcium and vitamin D deficiency may result in rickets in children, premature tooth loss and (14) _______. G _________________________ This contributes to tooth decay and many foods that are high in sugar are also high in fat. Excessive sugar intake may contribute to the onset of (15) _______. H _________________________ Excessive consumption leads to a variety of health problems such as cirrhosis of the (16) _______ and cardiovascular disease. Alcoholic drinks are also very high in calories and can contribute to obesity. MY GLOSSARY calcium n. 钙 fat n. 脂肪 adj. 肥胖的；厚的 sodium n. 钠 cholesterol n. 胆固醇 complex adj. 复杂的 carbohydrate n. 碳水化合物 alcohol n. 酒；酒精，乙醇 moderation n. 适度，适中；合理 calorie n. 卡，卡路里（测量食物所 含热量的单位） saturated fat 饱和脂肪 legume n. 豆荚 mineral n. 矿物质 antioxidant n. 抗氧化剂 scurvy n. 坏血病 folic acid 叶酸 clotting adj. 凝血的 haemorrhage v. 大出血 rickets n. 佝偻病 cirrhosis n. 肝硬化 4 Test your partner about the following questions. 1) Name 2 conditions related to lack of calcium and vitamin D. 2) Where do we find saturated fats? 3) What do antioxidants do? 4) Name 3 citrus fruits. 5) What is another term for coagulant? 6) Name 2 conditions related to an excessive intake of sugar. 7) Name 2 dietary causes of cardiovascular disease. 8) What types of food contain fibre? 9) Name 3 dairy products. 5 Read the text about why the elderly don’t eat properly and insert the headings in the spaces A–H. Reduction in senses of smell and taste Problems with chewing Loneliness Reduction in sense of sight Unwillingness to cook Medications Constipation Lack of knowledge and motivation Proper nutrition is vital for maintaining health, retaining and building bone mass and, importantly, to enable medications to work effectively in the body and possibly with fewer side effects. Here are some of the reasons why the elderly sometimes don’t eat properly, according to the National Institute of Health and Aging. A _________________________________ Eating involves many senses, aromas, colours and tastes in one’s mouth; but many elderly people’s sense of smell and taste are reduced as they age. As a result the food does not taste so good. B _________________________________ Cataracts and other eye conditions reduce visual perception of the food, making it less attractive. Good lighting may help as will brightly coloured food. C _________________________________ Some drugs change the sense of taste or reduce appetite. Speak to your GP if the prescribed medications or medical treatments are causing loss of appetite, or a bad taste. You may be able to substitute with a different medication, or prescribe an added medication to correct the problem. D _________________________________ A side effect of many prescription drugs is constipation, and as a result a lack of appetite. Combat constipation by increasing the amount of water the patient drinks throughout the day. Fear of incontinence often makes the elderly drink less. Increasing the percentage of food that will actually help with intestinal movement is also necessary. E _________________________________ If the patient has tooth or gum problems or badly fitting dentures, this will make eating painful and difficult. It is important to have regular dental checkups even for edentulous patients. Chewing problems can often be resolved by eating softer foods such as soft fruits, juices, minced or slow-cooked meats, eggs, fish and legumes. F _________________________________ A meal is often enjoyed more when the event is shared with another person or a group. G _________________________________ If the patient understands the vital role of nutrition in his or her life, he or she may be more interested in eating well. Tell the patient that proper nutrition is fundamental to health and independence. H _________________________________ If the patient can’t or won’t prepare meals, call for help. There may be a Meals on Wheels programme for the elderly available in the community. This program prepares hot and healthy dishes and delivers them daily. MY GLOSSARY nutrition n. 营养物质；营养，滋养 vital adj. 必不可少的；极其重要的 maintain v. 维持；维修，保养；坚持 medication n. 药物，药剂 side effect 副作用 properly adv. 合适地，适当地；正确地 involve v. 包括，包含；涉及，牵涉 sense n. 官能；感觉，知觉 aroma n. 香味，香气，芳香 cataract n. 白内障 visual adj. 视觉的，视力的 appetite n. 食欲，胃口 prescribe v. （医生） 开（药）， 为……开（药），嘱咐 （疗法）；规定，指定 substitute v. 用……代替 n. 替代品 constipation n. 便秘 combat v. 与……战斗，与……作斗 争；打击 intestinal adj. 肠的 edentulous adj. 缺齿的 fundamental adj. 基础的，基本的；主要的 independence n. 自主，自立，独立 6 Read the text and complete the table on the next page. In a hospital context the nurse’s role is fundamental in assessing the needs of patients regarding feeding and nutrition. Some patients may need help with eating due to weakness or physical incapacity. Neonatal nurses are often occupied with feeding babies with serious health problems and resulting feeding difficulties. They may be fed by bottle or through a nasogastric tube depending on how strong they are. Scrupulous hygiene is extremely important as newborns have no immune defences. Feeding in the high dependancy unit will be either through a nasogastric tube which is inserted into the stomach through the nose, or a gastronomy, which is inserted into the stomach through an opening in the abdomen wall. Patients who have had major gastrointestinal surgery and cannot digest food, either temporarily or long-term, are fed by means of parenteral nutrition whereby the nutritional substances are fed directly into the bloodstream through an IV catheter. For long-term IV feeding in particular there is an increased risk of infection and sepsis. MY GLOSSARY incapacity n. 无能力 nasogastric adj. 鼻饲的 scrupulous adj. 严格的，严谨的，小心 的，审慎的 gastronomy n. 留置胃管 abdomen n. 腹部，下腹；腹腔 gastrointestinal adj. 胃肠的 parenteral adj. 胃肠外的， 不经肠道的 IV catheter 静脉导管 sepsis n. 败血症 Type of Patient Methods of Feeding and Notes immobilised neonatal high dependancy gastrointestinal tract surgery 7 Match the words with the definitions. 1) assess a material with particular physical characteristics 2) weakness b the fact or state of not being strong or powerful 3) incapacity c to judge or decide the amount, value, quality, or importance of something 4) neonatal d of or for babies that were born recently 5) occupy e the fact that you are unable to do something because you do not have the ability or you are too weak 6) scrupulous f to keep someone busy or interested 7) immune g protected against a particular disease by particular substances in the blood 8) digest h doing everything correctly and exactly as it should be done 9) temporarily i to change food in your stomach into substances that your body can use 10) major j a method or way of doing something 11) means k more important, bigger, or more serious than others of the same type 12) substance l in a way that does not last for long or for ever Listening 8 Listen and complete the text about childhood obesity. Childhood obesity is associated with a (1) ____________ chance of premature death and disability in adulthood. (2) ____________ and obese children are more likely to stay obese into adulthood and to develop non-communicable diseases (NCDs) like (3) ____________ and (4) ____________ diseases at a younger age. For most NCDs resulting from obesity, the risks depend partly on the (5) ____________ of onset and on the (6) ____________ of obesity. Obese children and adolescents suffer from both (7) ____________ and long-term health consequences. The most significant health consequences of childhood overweight and obesity, that often do not become apparent until adulthood, include: . cardiovascular diseases (mainly heart disease and (8) ___________); . (9) ____________; . musculoskeletal disorders, especially (10) ____________; . and certain types of (11) ____________ (endometrial, breast and colon). 9 Find words in the text in Exercise 8 and match them with their synonyms below. 1) connected ____________ 2) early ____________ 3) remain ____________ 4) start ____________ 5) obvious ____________ Speaking 10 Look at the photos. What dietary issues does a nurse have to consider in these situations? a b 11 Match the groups of questions with the photos in Exercise 10 and practice the conversations with your partner. c d 1) . What have you eaten today? . Do you have someone to help you to cook? . What is your favourite food? . Do you need someone to help with your shopping? 2) . Are you feeding on demand? . Is it very painful when you feed? You might have inflammation. . Does the baby sleep after each feed? . Does he cry a lot after feeding? . Have you weighed him after each feed to see how much he is eating? 3) . Does worrying about food and weight dominate your life? . Does it stop you from participating in ordinary social contexts? . Do you find it difficult to eat with others? . Do you have irregular periods / menstrual cycle? . Do you feel out of control with your weight? 4) . Is your son a fussy eater? . Does your son do any sport? . Are other people in the family overweight? . What sort of snacks does he eat? . Does the family eat fruit and vegetables? . Do you usually have fizzy drinks in the fridge? Writing 12 Read and highlight the key facts in the following article about children nutrition and construct a mind map—a diagram showing how ideas relate to each other. Healthy Breakfasts for Kids: It’s All About Balance A healthy breakfast is a must for kids. Skip it and your kids will be playing nutritional catch-up for the rest of the day, says Carole L. Adler, a dietitian at the Food and Drug Administration (FDA). When kids skip breakfast, they don’t get what they need to be at their best, says Adler. “Growing bodies and developing brains need regular, healthy meals,” she says. According to the Academy of Nutrition and Dietetics, studies show that school children who eat breakfast perform better in the classroom. As with other meals, it’s a good idea for your kids (and you) to eat a healthy balance of fruits and vegetables, proteins, grains and dairy—not just for breakfast but throughout the day. Here are some quick and easy breakfast tips to ensure your children start their day off right. Keep in mind that nutritional balance is key—not just for one meal but for foods eaten throughout the day. Prepare extra carrot, celery, and broccoli sticks with a hummus dip as an afternoon snack. Growing bodies need nourishment. If your kids are physically active, they need plenty of calories to keep them fuelled. Adler says that having a breakfast that contains protein, fat and carbohydrates helps children feel full and stay focused until lunch. Protein choices might include an egg, some nuts, a slice of deli meat or cheese, or a container of yogurt. When time is short, hand your kids something healthy as they head out the door, like a piece of fruit, a bag of nut-and-fruit trail mix, or a whole-wheat tortilla spread with peanut butter or almond butter, and a carton of milk. “A fruit-filled shake with milk or yogurt takes only a couple of minutes to drink,” Adler says. MY GLOSSARY play catch-up 紧紧追赶 dietitian n. 饮食保健专家；营养学家 hummus n. 鹰嘴豆泥 tortilla n. 玉米粉薄烙饼 carton n. （装牛奶、果汁 或其他商品的）硬纸盒，塑 料盒 A B C A B Main Idea C Nursing and Society Nutrition Project to Improve Students’ Physical Fitness An action plan for 2019–2030 devised by a State Council special committee was made public in July, specifying the objectives, tasks and responsibilities of each campaign. Major health concerns in society, including psychological health, student myopia, child obesity and cancer, were covered by the campaigns. Malnutrition, including undernutrition, hidden hunger and obesity, threatens the survival, growth and development of children and young people, according to the State of the World’s Children 2019 report released by the United Nations Children’s Fund (UNICEF). According to the report, globally, obesity among children and adolescents continues to rise. From 2000 to 2016, the proportion of overweight children and youth (aged between 5–19) rose from one in ten to almost one in five. Under the guidance of the disease control bureau under the National Health Commission, the National Institute for Nutrition and Health under the Chinese Centre for Disease Control and Prevention, the Beijing Centre for Disease Prevention and Control and the Centre for Disease Prevention and Control of Shunyi District launched the “Nutrition School” pilot project in 2016. UNICEF supported the preliminary research work of the project, including through financial and technical support, and promoted obesity intervention in all aspects. Discussion What problems does the “Nutrition School” project aim to tackle? Unit 6 Diet and Nutrition 77 UNIT Respiratory Care 7 Learning Objectives Upon completion of the unit, students will be able to: . understand the gas exchange mechanism and pathology of asthma; . know the normal respiratory rate of different ages; . have the knowledge of using Ventolin asthma inhaler and pulse oximeter. Starting Off 1 Look at the equipment and label the pictures with words or phrases from the box. Who might need to use which piece of equipment? Discuss with a partner. oxygen mask asthma inhaler nebuliser nasal oxygen tube 1) _____________________ 2) _____________________ 3) _____________________ 4) _____________________ 2 Work with a partner to label the diagram. 1) lower lobe 2) alveoli 3) pulmonary venule 4) trachea 5) pulmonary arteriole 6) upper lobe 7) bronchiole 8) heart 9) diaphragm a b d e c f g h i MY GLOSSARY lower lobe （尤指大脑、肺、 肝等器官的）下叶 alveoli n. 肺泡 pulmonary venule 肺部微静脉 trachea n. 气管 pulmonary arteriole 肺部动脉 bronchiole n. 细支气管 diaphragm n. 膈，膈膜 3 Match the words or phrases with their opposites. a to inhale b to contract c into d to raise e downwards f to push g upper h more i to decrease j outside k narrow 1) to expand 2) lower (adj.) 3) out of 4) upwards 5) less 6) inside 7) to exhale 8) to pull 9) to increase 10) to lower 11) wide Reading 4 Read the text and match the headings in the box with the paragraphs. Mucus production Inflammation Tightening of the muscles lining the airways The immune system and immune response cause the symptoms of asthma. In asthma, the muscles around the airways are very sensitive and overreact to substances that other people tolerate without problem. Asthma symptoms are caused by 3 main physiological processes: 1) _____________________ This contraction or tightening of the bronchial smooth muscles is called bronchospasm or bronchoconstriction. The muscles tighten around the outside of your bronchial tubes causing narrowing and it becomes more difficult to move air through the lung resulting in breathing difficulties, chest tightness or wheezing. 2) _____________________ In addition to the bronchoconstriction, airways of the lung produce an increased amount of mucus. This can lead to mucus blocking and narrowing the airways, making symptoms worse. 3) _____________________ The inside of the airways becomes swollen and inflamed. This swelling also decreases airflow and makes it more difficult to breathe. The inflammation is generally the third phase of an asthma attack. MY GLOSSARY bronchospasm n. 支气管痉挛 bronchoconstriction n. 支气管狭窄，支 气管缩小 wheeze v. 喘息，气喘，哮喘 mucus n. （黏膜分泌的） 黏液 block v. 阻塞，阻 止 swollen adj. 肿胀的，浮肿的 inflamed adj. 发炎的，红肿的 5 Label the picture with the words. 1) inhaler 2) canister 3) mouthpiece 4) cap/lid 6 Read the instructions for the Ventolin asthma inhaler. Put them into the correct order. Remove Ventolin cap. Place middle or index finger onto canister and thumb underneath the mouthpiece of the inhaler. a Put the cap back on. b Put the mouthpiece in your mouth and close your lips around it. c Shake inhaler for 5–10 seconds and remove the cap. d Press canister once to release medication and continue to breathe in slowly until lungs are full (do not breathe out). e Hold your breath for 5–10 seconds, and then breathe out. f Breathe out fully (in preparation to breathe in medication). g If your physician has prescribed more than one dose (puff), wait for 30 seconds and repeat above. a b c d MY GLOSSARY Ventolin asthma inhaler 喘乐宁气雾剂 canister n. 金属罐 7 Read the text on pulse oximetry and match the questions with the paragraphs. a How does the oximeter work? b What might affect the results? c What does pulse oximetry measure? 1) __________________________________ It is a non-invasive test which measures the level of haemoglobin saturation in the blood. It is quick and easy to perform. Haemoglobin is a molecule which is present in red blood cells. It transports gases, in particular oxygen, around the body to oxygenate all body tissues. SpO2 is the abbreviation for oxygen saturation % in red blood cells. 2) __________________________________ There are different types of oximeter. They all have a microprocessor box which measures and displays the SpO2 and a cable which is attached to the probe/sensor. The probe/sensor is a clip which is in contact with the skin of the finger or ear-lobe. On one side there are two lights—one red light and one infra-red light. On the opposite side is a photo detector which detects the light that passes through the tissues and passes the information to the microprocessor. Oxyhaemoglobin absorbs infra-red light, so the microprocessor uses the level of infra-red light absorbed to calculate the level of oxyhaemoglobin saturation and the pulse rate. The normal value of oxygen saturation is 95%–100%. Any result below 90% should be reported. 3) __________________________________ There are a number of factors that can cause inaccurate measurements of SpO2 and there are conditions where other types of test should be done. The probe clip must be the correct size. The probe must not be applied to a pierced ear-lobe. The probe must not be attached to a finger with dark nail varnish. Patients who have problems with peripheral circulation should also have blood gas analysis tests. MY GLOSSARY oximeter n. 血氧定量计 oximetry n. 血样定量法 haemoglobin n. 血红蛋白 saturation n. 饱和， 饱和度 abbreviation n. 缩略，缩写；简称 ear-lobe n. 耳垂 infra-red light 红外线 oxyhaemoglobin n. 氧合血红蛋白 pierced adj. 穿孔的，刺穿的 nail varnish 指甲油 peripheral adj. 外围的；（神经） 末梢区域的 8 Read the text about a doctor’s advice and match the headings in the box with the paragraphs. Good: High-fibre foods Clean your humidifier Stay active Clean your carpets Check your air quality Laugh more Bad: Processed meats 1) __________________________________ You might already know that exercise helps keep your heart healthy, but it’s also good for your lungs. It can even improve the symptoms of some long-term lung conditions. If the gym is not your thing, a walk, jog, or regular tennis game can do the trick. Shoot for about 30 minutes, five times a week. Just make sure to talk to your doctor about your exercise plan if you already have breathing problems. 2) __________________________________ It’s just a simple device that puts moisture into the air to help you breathe easier, right? Well, yes. But if you don’t clean it, it could develop an airborne fungus that can infect and inflame your lungs. That’s why it’s important to change filters and do regular maintenance on your humidifier and your air heating and cooling systems, too. 3) __________________________________ What do peas, lentils, and black beans have in common? They are all high in fibre, which is great for your lungs. Research suggests people who eat more fibre have lungs that work better than those who don’t eat much fibre. Other fibre-rich foods include baked beans, seeds, pears, and broccoli. 4) __________________________________ It’s a good idea to vacuum your carpets three times a week and steam clean them every year. That is because they can trap mold, cockroach droppings, dust mites, dirt, and dust that get into the air and into your lungs. Even the chemicals used to make and install carpet could cause lung problems. If that’s too much vacuuming for you, consider hard-surface flooring, like tile or wood, which is easier to keep clean. 5) __________________________________ Studies show a link between processed, or cured meats and worse lung function. Researchers think the nitrites used in processing and preserving cured meats may cause inflammation and stress to the lungs. Bacon, ham, deli meat, and sausage all fall into the category of processed meats. 6) __________________________________ The Air Quality Index (AQI) tracks pollution that may come from factories, fires, cars, dust, pollen, and other sources on a scale from 0 to 500. Get local levels on the news or check online. Dirty air could affect anyone, but high levels are especially serious for children, adults over 65, and people who are ill. When levels are really high, it’s often safer to stay indoors as much as possible. 7) __________________________________ It is a great workout for your stomach muscles and helps increase the amount of air your lungs can take in. Much like sports, jogging, or breathing exercises, a good laugh clears out stale air to make room for fresh air that can reach more parts of your lungs. MY GLOSSARY moisture n. 水分；湿度 airborne adj. 在空气中的；空气传播的 fungus n. 真菌 filter n. 过滤器 humidifier n. 加湿器 lentil n. 小扁豆 broccoli n. 西蓝花 vacuum v. 用真空吸尘器 清扫 cockroach n. 蟑螂 mite n. 螨虫 nitrite n. 亚硝酸盐 pollen n. 花粉 stale adj. 陈腐的；不新鲜的 9 Fill in each space with a word from the box. pollute inflammation cough sodas obstructive sweetened fumes bronchitis Do your lungs a favour and swap out soft drinks for water. A study found adults who drank more than five (1) ________________ soft drinks a week were more likely to have ongoing (2) ________________, and kids were more likely to have asthma. It’s not clear that the (3) ________________ were the reason why, but the pattern stood out. If you smoke, even unsweetened soft drinks can be bad for your lungs. Tomatoes are the richest source of lycopene, which is linked to lung health. Eating tomatoes and tomato products like tomato juice can improve airway (4) ________________ if you have asthma and may lower your chance of death if you have chronic (5) ________________ pulmonary disease (COPD). Lycopene is also tied to less decline in lung function for young adults. These benefits are even more pronounced for people who used to smoke. Exhaust from cars, trucks, and other vehicles (6) ________________ the air. If you live in a city and regularly breathe in traffic (7) ________________, you may have chronic (long lasting) bronchitis. This is when the lining of the bronchial tubes, which carry air to your lungs, gets inflamed. If you have it, you may have shortness of breath and (8) ________________ up thick mucus that may be white, yellow, or green. MY GLOSSARY swap v. 交换，互换 lycopene n. 番茄红素 pulmonary adj. 肺的 pronounced adj. 显著的 bronchitis n. 支气管炎 Listening 10 Look at the diagram of gaseous exchange. Then listen and complete the text. The lungs are part of the (1) ___________ system which is adapted for two functions: a ventilation—the movement of air (2) ___________ and (3) ___________ of the lungs; b gas exchange—the “swapping” of (4) _________ between the alveolar air and the (5) __________. The (6) ___________ are located within the upper part of your body called the thorax. They are surrounded by the ribcage and between the ribs are intercostal (7) ___________ which play a role in ventilation. When you inhale: The intercostal muscles (8) ___________, expanding the ribcage outwards and upwards. The diaphragm (9) ___________, pulling downwards to (10) ___________ the volume of the chest. Pressure inside the chest is (11) ___________ and air is (12) ___________ into the lungs. When you exhale: The intercostal muscles (13) ___________, the ribcage drops inwards and downwards. The diaphragm (14) ___________, decreasing the volume of the chest. Pressure inside the chest increases and air is (15) ___________ out. The gas that is exhaled contains (16) ___________ times more carbon dioxide (CO2) than inhaled gas. Gas Exchange in Humans 11 Listen and fill in each space with a word from the box. 10–15 stethoscope rapidly 20–25 decreased differences symptoms mouth size constant heart lower monitor health Nurses work in many contexts where it is necessary to (1) ________________ patients’ respiration. There are considerable (2) ____________________ in respiratory rates. This varies according to age, (3) ______________, sex and (4) _____________ condition. A normal rate for healthy adults is (5) ______________ breaths per minute. Difficulty in breathing is known as dyspnoea. (6) ____________ of dyspnoea in adults include the use of abdominal muscles during breathing and (7) ______________ breathing, as well as an increased respiratory rate. Young children breathe more (8) ______________ and also use their diaphragm muscle resulting in more abdominal movement than is normal in adults. A child of under 1 year typically takes 25–35 breaths per minute, children under 5 take 20–30 breaths per minute, children of 5 to 12 take (9) ______________ and children over 12 take 15–25. An increased respiratory rate is termed tachypnoea and a (10) ______________ respiratory rate is termed bradypnoea. Not breathing is termed apnoea. In healthy people, the pulse to respiration ratio is (11) ______________—1 breath for every 4/5 (12) ______________ beats. Respiratory rates of over 40 per minute in an adult should be reported immediately. The nurse should observe and count the rise and fall of the chest after taking the pulse rate. With young children the nurse must place his/her hand on the (13) ______________ part of the chest to feel the movements while taking the pulse. The sounds of respiration can also be monitored with a (14) ______________ placed on the chest. The respiration rate must be recorded on the patient chart. MY GLOSSARY ventilation n. 通风设备；空气流通 alveolar adj. 肺泡的；齿槽的 thorax n. 胸，胸廓 ribcage n. 胸廓，胸腔 intercostal adj. 肋间的 Description: Macintosh HD:Users:adrienneharrison:Desktop:stock-photo-man-doing-fitness-test-on-exercise-bike-at-the-medical-centre-244063741.jpg MY GLOSSARY stethoscope n. 听诊器 respiration n. 呼吸；呼吸作用 dyspnoea n. 呼吸困难 abdominal adj. 腹部的；有腹鳍的 tachypnoea n. 呼吸急促 bradypnoea n. 呼吸缓慢 apnoea n. 呼吸暂停 Writing 12 Complete the words in the table using the information in Exercise 11. The first letter has been given. Breathing Problems Factors in Measuring Respiratory Rates Methods of Measuring Respiratory Rate D ________________________ A _______________________________ Count r__________ and f__________ of chest A ________________________ S _______________________________ Place h__________ on l__________ chest area of child B ________________________ S _______________________________ Measure pulse rate too T ________________________ H _____________________ condition Use a s__________ to listen to respiratory sounds Speaking 13 Look at the diagrams of the airways. Where is the airway the narrowest? Where is it the widest? Where can you see inflammation? Discuss with a partner. 14 Work with a partner and take turns. Student A gives your partner instructions for using an inhaler. Use these verbs: shake / remove / breathe out / put / press / breathe in / hold / wait / put on. Student B acts out the instructions. Nursing and Society Most Adults with Asthma Unaware They Are Affected More than 70 percent of adults with asthma in China are not aware they have it, highlighting the urgency for improved diagnosis and treatment, new research shows. Led by the China-Japan Friendship Hospital, the study estimated there are more than 45 million adults with asthma, with a rate of about 4.6 percent for men and 3.7 percent for women. Smokers are more likely to suffer asthma, and among nonsmokers, air pollution both outdoors and indoors can increase their risks of getting the disease. The study was based on surveys of more than 50,000 residents in 10 provinces and municipalities. A paper on the research was published in the international medical journal Lancet last week. Asthma is a common disease, but surveys have shown many hospitals and clinics at the grassroots, especially in rural areas, lack adequate knowledge of it and cannot provide precise and standard treatment, a professor of pediatrics said. In addition to the vast number of adult asthma patients, China also has around 10 million minors with the disease who also deserve attention. National surveys done over the past three decades have shown that the incidence of asthma among people under 14 years old in urban areas in China has been increasing by 50 percent every 10 years. In many cases, respiratory diseases among adults are connected with poor health conditions when they are infants, including premature birth and serious lung infections, so reducing the incidence of asthma among the whole population should start with children, the professor said. Discussion What can we do to avoid suffering from asthma? UNIT Wound Care 8 Learning Objectives Upon completion of the unit, students will be able to: . classify the types of wounds; . understand the healing process of wounds; . follow the procedures in wound care. Starting Off 1 What can you see in the photos? Match each picture with a word or phrase. a b c d e f 1) burned arm 2) grazed knee / abrasion 3) scar tissue 4) scab 5) ulcerated leg 6) skin healing sutures / stitches How did it happen? Match the pictures with the causes. 1) cooking—I was frying some eggs and my arm touched the frying pan. 2) cycling—Mark fell off his bicycle and hurt his knee. 3) knife attack—In 2001, a man with a knife attacked my father and took his money. 4) vascular-circulatory disease—My grandmother has problems with diabetic ulcers. They never heal properly. 5) Surgical operation—Jim had his appendix removed. The stitches will be removed in two weeks. MY GLOSSARY graze v. 擦伤 abrasion n. 擦伤 ulcerated adj. （皮肤）溃烂的 suture n. （缝合伤口的）一针，缝针 stitch n. 缝针 diabetic ulcer 糖尿病溃疡 appendix n. 阑尾 Reading 2 Look at the pictures and read the text about wound healing. Insert the headings in the spaces. Then listen and check your answers. 1) The maturation phase 2) The proliferative phase 3) The inflammatory phase 4) Wound healing 5) The destructive phase 6) What is a wound? A _________________________ A wound is defined as a defect or a break in the skin that results from physical, mechanical or thermal damage or as a result of the presence of a physiological disorder. B _________________________ This is a very complex phenomenon. Different wounds do not necessarily follow the same pattern in the healing process. When wounds are confined to the epidermis and dermis, they will heal by regeneration. Wounds extending through the dermis heal by scar formation, composed of connective tissue, because deeper tissues such as hair follicles and subcutaneous tissue are not able to regenerate. Connective tissue is developed from cells called fibroblasts. The healing process is usually described in four phases: C _________________________ This prepares tissue for repair. This protective mechanism aims to minimise injury and initiate the healing response. The wound appears swollen, red and warm. D ________________________ This breaks down damaged tissue and the wound is cleaned of devitalised/dead tissue by white blood cells. There may be liquid and a scab. E _________________________ This rebuilds the tissue. Collagen and an elastic mesh is formed. New blood cells grow to form granulation tissue. The wound is smaller and red dots show that the granulation tissue is forming. F _________________________ This phase involves remodelling of the tissue and can take up to 2 years. The scar is often white and hard. MY GLOSSARY maturation n. 成熟；化脓 proliferative adj. 增生的；繁殖的 blood clot 血块 fibroblast n. 成纤维细胞，纤维母 细胞 macrophage n. 巨噬细胞 subcutaneous adj. 皮下的 phenomenon n. 现象；奇才；奇迹 follicle n. 毛囊 devitalise v. 失去生命 scab n. 疤，痂 collagen n. 胶原蛋白 elastic adj. 有弹性的 mesh n. 网，网状物 granulation n. 粗糙；使成粒状 granulation tissue 肉芽组织 3 Read the text in Exercise 2 again. Are the following sentences true (T) or false (F)? T F　　　　 1) Wounds do not always result from injury. 　　　　 2) Wounds can be caused by an illness. 　　　　 3) Wounds affecting the hypodermis heal by regeneration. 　　　　 4) In the destructive phase the wound may be wet. 　　　　 5) Fibroblasts are involved in tissue healing in the hypodermis. 　　　　 6) Maturation is a quick process. 　　　　 4 Find words or phrases in the text in Exercise 2 and match them with their similar meanings below. 1) grow again (v.) _____________________________ 2) build again (v.) _____________________________ 3) shape again (v.) _____________________________ 4) stage (n.) _____________________________ 5) under the skin (adj.) _____________________________ 6) limited (adj.) _____________________________ 7) decompose (a phrase) _____________________________ 5 Work with a partner and find these objects in the photos. 1) scissors 2) tweezers 3) micropore tape 4) bandage 5) forceps 6) dressing/gauze 7) sterile dish 8) gloves 9) disinfectant 10) irrigation bulb a b c MY GLOSSARY scissor n. 剪刀 tweezer n. 镊子，钳子 micropore tape 微孔胶布 forcep n. （医用）镊子， 钳子 disinfectant n. 消毒剂，除菌剂 bulb n. 球茎，球状物 6 Read and match the headings in the box with the following paragraphs. Signs of adhesive or latex allergy A bit of blood is good Recognising signs of infection To bandage or not to bandage Cleaning cuts and scrapes gently Quick care for minor burns 1) __________________________________ Ouch! Got another cut or scrape? Your first step is easy: soothe and clean the wound with cool water. Then remove any pebbles or splinters with alcohol-sterilised tweezers. Gently wash around the wound with soap and a washcloth. Do not use irritating soap, iodine, alcohol, or hydrogen peroxide—fresh, clean water should be all you need. 2) __________________________________ Blood helps clean wounds, so a little bleeding is good. Most small cuts and scrapes stop bleeding pretty quickly, but you can help by applying firm, gentle pressure with gauze or a tissue. If blood soaks through, put another piece of gauze or tissue on top, don’t remove the old one or you may separate the wound and start the bleeding again. 3) __________________________________ If your scrape will be rubbed by clothes, cover it with a bandage. An uncovered scab or scrape is at risk of reopening or infection. When in doubt, cover it up with an adhesive bandage to keep out the bacteria, and then change the bandage daily. 4) __________________________________ If you feel like it is itchy, blistery, or burning under your bandage, you may have an allergy to the adhesive used in some bandages. For sensitive skin, try switching to sterile gauze and paper tape, or an adhesive-free dressing. 5) __________________________________ Most of us have had a small burn or two. To treat one, cool the area right away with a cold cloth or cool running water to keep the skin from holding the heat and continuing to burn. Afterward, wash the burn with soap and water and dress it lightly. Leave any blisters that form alone—they help to protect the skin as it heals. 6) __________________________________ If there is skin redness that spreads out from your injury, swelling, green or yellow fluid, or increased warmth or tenderness around the wound, you may have an infection. Other signs include swollen lymph nodes at your neck, armpit, or groin, as well as body aches, chills, or fever. If you have any of these signs, give your doctor a call. MY GLOSSARY adhesive n. 黏合剂；胶带 latex n. 橡胶，乳胶 scrape n. 擦痕 pebble n. 砾石，卵石 splinter n. 碎片；细小的东西 iodine n. 碘，碘酒 hydrogen peroxide 过氧化氢，双氧水 itchy adj. 发痒的 blistery adj. 起泡的 blister n. 水疱 lymph node 淋巴结 armpit n. 腋窝 groin n. 腹股沟 7 Match the words with the definitions. 1) epidermis 2) abrasion 3) follicles 4) collagen 5) forceps 6) gauze a a protein found in the bodies of humans and animals b any of the very small holes in the skin, especially one that a hair grows from c a very thin, light cloth, used to make clothing, to cover cuts, to separate solids from liquids, etc. d a metal instrument with two handles used in medical operations for picking up, pulling and holding things e the thin outer layer of the skin f the process of rubbing away the surface of something 8 Read the note and fill in the blanks. Dr. Rovee and Wound Treatment In 1972, Dr. Rovee proved experimentally that when a wet wound is cleaned without scab, epithelial cells migrate and proliferate faster than when a scab is formed. If a wound can heal in a moist micro environment, it can maintain the most appropriate environment necessary for cell activity, facilitate the transport of key cells, resist microbial invasion and improve the formation rate of epithelial cells. 1) _________________ proved wet healing theory of wounds experimentally. 2) A moist micro environment is beneficial for ___________________________________________________. 3) Epithelial cells migrate and proliferate faster _______________________ than _____________________. MY GLOSSARY epithelial adj. 上皮的，上皮组织的 Listening 9 Listen and complete the notes and table about wound assessment. A formal assessment is not necessary for minor wounds. Wounds which do not (1) _____________ normally or are the result of an (2) _____________ must be assessed and (3) _____________. Different colours are associated with different types of wounds. Black necrotic / (4) ___________ tissue Yellow accumulation of dead cells typical of the end of (5) ____________________ stage Red granulation (6) ___________ Pink epithilisation. The new (7) ___________ ___________ grow across the wound to meet in the centre MY GLOSSARY necrotic adj. 坏死的 accumulation n. 积累，积聚 epithelisation n. 上皮形成， 上皮化 Writing 10 Look at the two categories of wounds and try to describe their characteristics. The word reference may help you complete the task. Word reference: heal rapidly, complications, underlying health problem, systemic illness, prolonged, excessive Acute wounds Chronic wounds knife wound: pressure sore: appendectomy wound: diabetic ulcer: burn: cancer ulcer: animal bite: venous leg ulcer: MY GLOSSARY appendectomy n. 阑尾切除术 sore n. 痛处；溃疡 venous adj. 静脉的 Nursing and Society Chinese Scientists Develop New Wound Dressing Material Chinese scientists have developed a new kind of adhesive antibacterial hydrogel that can be used in wound healing treatment. A wound dressing is essential for skin wound healing, and designing wound dressing materials with antibacterial properties, therapeutic effects and suitable mechanical properties has practical significance in health care. Hydrogel wound dressings have gained popularity in recent years, but they have shortcomings such as an inability to fit the skin and a lack of antibacterial properties. Researchers with Xi’an Jiaotong University in Northwest China’s Shaanxi province have designed a self-healing, injectable hydrogel that has multiple functions as a wound dressing, especially for joint skin damage. With high adhesion, the hydrogel can quickly seal wounds of any shape and bond with the wound’s edge, providing a physical barrier against contaminants while simulating moist skin conditions. The hydrogel can help stop bleeding and prevent wound infection, promoting rapid healing of the wound. Also, the skin-like material exhibits stretchable and compressible properties, which significantly reduce the discomfort associated with traditional wound dressings. The hydrogel has great potential as an effective bioactive wound dressing. The research was published in the journal Biomaterials. Discussion What are the advantages of the new would dressing material developed by Chinese scientists? UNIT Administering Drugs 9 100 护理英语 Learning Objectives Upon completion of the unit, students will be able to: . recognise different types of medications; . describe the advantages and disadvantages of different types of medications; . describe the side effects of drugs. Starting Off 1 Match the pictures with the words or phrases. 1) injection 2) patch 3) inhaler 4) pills/tablets 5) suppository 6) sublingual spray 7) capsules 8) gel/cream 9) drops 10) suspension syrup a c b d e f g h i j Reading 2 Read the text and insert the headings in the box in the spaces. General sale list Pharmacy only Prescription only medicine Under the Medicines Act, medicines are divided into three categories: 1) _________________________: These can only be obtained on a prescription. In hospitals, almost all medicines are prescription only (POM) and patients will have a prescription chart. 2) _________________________: This is a restricted list of simple medicines (OTC) that can be freely sold in almost any outlet, for example supermarkets and stores, over the counter. 3) _________________________: These medicines can only be sold in the presence of a pharmacist (P), but they do not require a prescription. 3 Read the text and answer the question: Are all dangerous drugs classified as “controlled drugs”? Certain drugs are classified as “controlled drugs”. They must be kept locked in a secure place. They are not always more toxic to the body than other OTC drugs (a packet of paracetamol, for example, could kill you), but they are addictive, so it is necessary to control their use. Controlled drugs are divided into “schedules” or levels depending on how addictive they are. The sedative temazepam is schedule 2, and pethidine is schedule 4. These drugs can only be ordered by a registered nurse or doctor and must be counter-checked by another qualified professional. The dose and form of administration must be calculated and checked and all the information registered, signed and counter-signed in the Register of Controlled Drugs. The keys for access to these drugs should be held by the nurse in charge. MY GLOSSARY toxic adj. 有毒的；中毒的 paracetamol n. 扑热息痛（一种镇痛 剂和退烧药） addictive adj. 使人上瘾的 temazepam n. 羟基安定（一种安定 药） pethidine n. 哌替啶（一 种麻醉镇痛 药） dose n. 剂量；一剂，一服 4 The words and phrases in the box are from the text in Exercise 3. Choose one for each of the following definition or synonym. signed drugs in charge addictive toxic counter-checked 1) medicines ______________________ 2) responsible ______________________ 3) creating dependence ______________________ 4) poisonous ______________________ 5) checked two times ______________________ 6) authorised by writing your name ______________________ 5 What do these drugs do? Match them with their functions. 1) analgesics a increase activity 2) diuretics b remove excess body fluid 3) antibiotics c relieve constipation 4) decongestants d suppress vomiting and nausea 5) narcotics e reduce and suppress swelling 6) anti-inflammatory drugs f make you sleepy and stop you from feeling pain 7) sedatives g calm and relieve anxiety 8) laxatives h kill bacteria 9) anti-emetics i help to clear a blocked nose 10) tranquillisers j help patients to sleep 11) anti-coagulants k remove pain 12) stimulants l make blood more fluid and prevent blood clots MY GLOSSARY analgesic n. 镇痛剂 diuretic n. 利尿剂 antibiotic n. 抗生素 decongestant n. 解充血药 narcotic n. 麻醉药 anti-inflammatory drug 消炎药 laxative n. 泻药 anti-emetic n. 止吐药 tranquilliser n. 镇静剂，安定药 anti-coagulant n. 抗凝血剂，抗凝 剂 stimulant n. 兴奋剂 6 Complete the gaps with suitable words from the following box. inhaler cream suppository spray patch syrup drops tablet 1) Take half a(n) ______________ every six hours. 2) Rub the ______________ into clean skin twice a day. 3) Put three ______________ in each eye morning and night. 4) Apply the adhesive ______________ after showering and apply a fresh one every day. 5) If you have an attack of angina, ______________ twice under the tongue and rest. 6) Paracetamol ______________ is recommended for paediatric patients. 7) A(n) ______________ would be better than a pill if you suffer from gastric reflux. 8) Use the ______________ before your start physical training to avoid an asthma attack. 7 Label the diagram with the words or phrases. 1) spine 2) thigh 3) syringe 4) gluteus maximus 5) sciatic nerve a b c d e Unit 9 Administering Drugs 105 8 Read the text and insert the missing information in the spaces. 1) ____________________________________________________ The gluteus maximus muscle on the buttock is a frequent site. Quarter the buttock and select the upper external quadrant. The sciatic nerve passes through the internal quadrant so injection there could damage the nerve. This site is not recommended for children because the muscle mass is too small. The deltoid muscle and the quadriceps are also good injection sites. 2) ____________________________________________________ Spread the skin to the left to create a Z track which will reduce the pain and insert the needle. 3) ____________________________________________________ Syringes are selected according to the volume to be injected. Needles are selected according to the type of injection and the site. Intramuscular injections require a needle long enough to penetrate the hypodermis and enter the muscle tissue. They are colour coded for easy identification. 4) ____________________________________________________ The site must be clean although sterilising is not necessary. Gloves must be worn at all times. After preparation of the injection and before use, the needle should be re-sheathed (covered) to avoid contamination. Needles must never be re-sheathed after use but should be placed in a sharps bin immediately. When administering injections care must be taken to avoid cross infection. Method. It is important to use appropriate equipment. If a needle-stick injury occurs. For intramuscular injections there are various sites which are suitable. 5) ____________________________________________________ Remove the needle quickly. Encourage the wound to bleed by applying indirect pressure. Then place the injured area under cold running water. Cover with addressing or plaster if required. Complete an incident form. MY GLOSSARY gluteus maximus 臀大肌 buttock n. 半边臀部 sciatic nerve 坐骨神经 quadrant n. 四分之一区域 deltoid muscle 三角肌 quadricep n. 四头肌 syringe n. 注射器 intramuscular adj. 肌肉的；肌肉内的 plaster n. 石膏；膏药 9 Read the text again in Exercise 8. Are the following sentences true (T) or false (F)? T F　　　　 1) The sciatic nerve is located in the upper external quadrant of the gluteus maximus. 　　　　 2) The muscles in the leg are good injection sites. 　　　　 3) The site must be sterilised. 　　　　 4) There are different types of needle for different types of injection. 　　　　 5) The needles can be identified by the colour. 　　　　 6) Try to avoid bleeding if you have a needle-stick injury. 　　　　 Unit 9 Administering Drugs 107 Listening 10 Listen and complete the text. Then listen again to check your answers. The (1) ______________ route is probably the simplest and most frequently used for drug administration. Tablets are very convenient. They often contain additives to prevent (2) ______________ to the gastrointestinal tract. (3) ______________ are oval shaped and coated in gelatine. They are used for bitter drugs. Remember never to open capsules. (4) ______________ are flavoured, sweet liquids and are particularly useful for (5) ______________. Sugar-free syrups are best. (6) ______________ are useful particularly when the oral route is impossible, for example, if the patient is vomiting, has a gastric condition or has convulsions. Absorption through the rectum is extremely rapid. (7) ______________ medications are absorbed through the mucosa under the tongue. The sublingual area is very vascular so absorption and effect of the drug is very (8) _____________. (9) ______________ medications are usually produced as tablets and are put between the gum and the lip. Again the effect is rapid. It is important to inform the patient that this type of medication is not to be swallowed. (10) ______________ medication consists of drug administration via the epidermis (the outer layer of skin) and external mucous membranes, such as the (11) ______________ and ears. Creams and ointments may be water or oil based. Eye ointment should always be applied to be inside of the lower eyelid. (12) ______________ are sealed with a peel-off sheet which exposes the part to be placed on the skin. Most are attached to the (13) ______________ or chest in a hairless area if possible. Drops are presented in solution in a (14) ______________ with a pipet or dropper at the end. Put the eye-drops inside the lower eyelid. (15) ______________ are produced under pressure and can be directed onto the area required. MY GLOSSARY tablet n. 药片 gelatine n. 胶质；果子冻；白明胶 syrup n. 糖浆；果汁 convulsion n. 抽搐；惊厥 sublingual adj. 舌下的 ointment n. 药膏 pipet n. 移液管，吸移管 11 Listen and complete the text about side effects. Perhaps the most common set of side effects for drugs taken (1) ______________ involves the gastrointestinal system. Nearly any drug can cause nausea, (2) ______________ and intestinal upset. For drugs used externally, (3) ______________ irritation is a common problem. Allergic reactions can happen with any drug and can range from (4) ______________ and a rash to a life-threatening anaphylactic shock reaction. Some drugs trigger side effects because of their (5) ______________ structure. One example is the common (6) ______________ drug diphenhydramine. This drug reduces allergy (7) ______________ but it also suppresses the activity of the body chemical acetylcholine. Low levels of acetylcholine causes drowsiness and other side effects, including dry mouth. Warfarin (an anti- coagulant) is used to prevent blood clots but serious internal (8) ______________ can occur. Side effects, known as interactions, may only occur when certain drugs are mixed with other things. For example drinking (9) ______________ with (10) ______________ painkillers has caused an increase in accidental overdose deaths. Drinking grapefruit juice can affect the blood levels of several drugs, including some blood (11) ______________ and cholesterol medicines. Information about side effects is found on over-the-counter drug products and on (12) ______________ drugs. It is also helpful to talk to your pharmacist or doctor if you have any questions regarding a drug’s side effects. MY GLOSSARY allergic reaction 过敏反应 anaphylactic shock 过敏性休克，过敏 反应休克 diphenhydramine n. 苯海拉明 acetylcholine n. 乙酰胆碱 drowsiness n. 睡意，困 倦，假寐 overdose n. 药量过多；（有害 物）过量 pharmacist n. 药剂师 Speaking 12 Discuss the following questions according to Exercise 1. Which are oral medications? Topical? Parenteral? What are the advantages/disadvantages of each type of medication? Writing 13 Write a short essay on one common medication you are familiar with and describe the side effects of this medication. Nursing and Society Dilemmas About Instructions for Administering Drugs and Indications for Their Use Over the past decades, the pharmaceutical industry has achieved great success in developing new drugs that contribute to the treatment of a large number of diseases. However, instructions for administering some drugs and indications for their use raise certain dilemmas and controversies questioning the appropriateness of the treatment. For example, statins are drugs that lower blood cholesterol level. However, current opinion is that they protect the blood vessel walls by inhibiting inflammation. Therefore, they are given to anyone at risk of cardiovascular diseases regardless of whether their blood cholesterol level is elevated or not. The rationale for using statins, in patients with normal blood cholesterol level, is highly debatable because it is very difficult to imagine a study design that could objectively confirm this. Also, it is very difficult or impossible to assess the effect of statin administration in patients with normal blood cholesterol level prior to the treatment. In addition, some studies suggest that statins can increase glycemic levels and lead to Type 2 diabetes. Discussion What dilemmas and controversies do statins raise? Is there any other drug raising some other dilemmas and controversies? Unit 9 Administering Drugs 111 UNIT Geriatric Patient Care and Diabetic Patient Care 10 Learning Objectives Upon completion of the unit, students will be able to: . know the symptoms related to geriatric patients; . recognise the key points of nursing geriatric patients; . understand the risk factors and complications of diabetes; . master the principles of care for people with diabetes. Section 1 Geriatric Patient Care Starting Off 1 1 Look at the elderly people in the photographs. What problems can you see? a b c d 2 Match the conditions with the symptoms. 1) deafness 2) incontinence 3) Alzheimer’s disease 4) rheumatism 5) impaired circulation 6) short-term memory problem 7) Parkinson’s disease 8) arthritis a My fingers are stiff, swollen and red. b I can’t control my bladder. c I shake and I can’t control my movements. d I have pains in my joints. e I can’t hear. f I feel cold and sometimes dizzy. g I can’t remember my name. h I can’t remember where I put my money. MY GLOSSARY Alzheimer’s disease 阿尔茨海默症 rheumatism n. 风湿病 Parkinson’s disease 帕金森氏病 dizzy adj. 眩晕的 1 Reading 3 Read the text and answer the question: Why do people live longer? With advances in medicine and scientific research and increased living standards, people live longer and the number of elderly people has increased dramatically. It is important that the elderly have the best quality of life possible and this depends on maintaining good health. This has financial and practical consequences. Many elderly people live alone but are not independent because of physical or mental health problems. With age, body functions deteriorate and there are circulatory, neurological, mobility and sensory consequences. Elderly people may have mobility problems, difficulty using their hands, memory problems or sensory problems and often need help with daily tasks such as washing, dressing, cooking, shopping or taking medication and collaboration between GP practice nurse and social worker is important. Elderly people are at increased risk of falling, due to motor and circulatory problems. As a result, hospitalisation for fractures or concussion are more common in the elderly. Protection in the joints in the human body decreases over time, so joint replacement operations also result in hospitalisation. In hospital the ward nurse plays a vital role in encouraging the patient to get out of bed and become mobile as soon as possible to avoid consequences such as bed sores, muscle deterioration or depression. The effects of years of poor diet, smoking or a sedentary lifestyle become evident in the elderly. Osteoporosis, obesity, diabetes and hypertension can result in, often leading to other, more serious conditions. MY GLOSSARY hospitalisation n. 住院治疗 fracture n. 骨折 concussion n. 脑震荡 deterioration n. 恶化，退化 sedentary adj. 久坐不动的 osteoporosis n. 骨质疏松症 4 Match the definitions with the words or phrases in green in the text in Exercise 3. 1) movement _________________ 2) high blood pressure _________________ 3) broken bones _________________ 4) skin lesions from pressure _________________ 5) autonomous _________________ 6) low bone density resulting in bones that break easily _________________ 7) get worse _________________ 5 Read the text in Exercise 3 again. Are the following sentences true (T) or false (F)? T F　　　　 1) Life expectancy has increased. 　　　　 2) Old people are healthier nowadays. 　　　　 3) Old people have a good memory. 　　　　 4) It is more important to have a good diet when you are old. 　　　　 5) Older people break more bones. 　　　　 6) The practice nurse helps patients in hospital. 　　　　 6 Match the words or phrases with the photographs. 1) walking frame 2) tripod walking stick 3) support bars / hand rails 4) wheelchair a ____________________ b ____________________ c _____________________ d ______________________ 7 Read the text and complete the sentences. A healthy lifestyle is important in preventing many diseases in later life. Calcium and vitamin D are necessary for strong teeth and bones and a lack of these minerals can cause problems such as tooth loss, osteoporosis and crumbling of the vertebrae. Anaemia is caused by a lack of iron and can make us weak and lifeless. A diet which does not include enough fibre can result in intestinal distress and chronic constipation. Diet is also a contributing factor in Type 2 diabetes. High cholesterol levels are related to cardiovascular disease, heart attack and stroke and excessive alcohol consumption can cause liver cirrhosis. Many people are unaware of what they should eat and why. Elderly people in particular often have a poor diet, for a variety of reasons. If they have poorly fitting dentures, eating becomes difficult and can be painful. With limited hand movement, cooking is complicated and tiring. Elderly people who are confused may not remember to eat and appetite may be reduced by medications for depression or by a lack of energy from being ill or in pain. 1) A lack of calcium and vitamin D can cause _______________________________. 2) A lack of iron _______________________________. 3) A diet that is poor in fibre _______________________________. 4) Type 2 diabetes is related to _______________________________. 5) High cholesterol levels are related to _______________________________. 6) Liver cirrhosis _______________________________. 7) Poor fitting dentures are _______________________________. 8) Cooking is complicated and tiring for people who _____________________________. 9) Medications for depression often ________________________________________. 10) A patient who is in pain _______________________________________________. MY GLOSSARY crumble v. 碎裂，崩塌；崩溃 vertebrae n. 椎骨 anaemia n. 贫血症 stroke n. 中风 Listening 1 8 Listen and complete the sentences. a ______________ are you? My ______________ David? No, my son David isn’t old. He’s ______________. I don’t know you. But you seem very nice. Thank you for coming to ______________. b I can’t keep warm. My ______________ are ______________ all the time. c I find it difficult to get out of bed. I have pains in my hips and my ______________ especially, and if I sit down for a while, my ______________ hurt. d I can’t ______________ a glass of water. My hands shake too much. e I can’t hold a ______________ because my ______________ are stiff and my joints are swollen. f Speak louder. I can’t ______________ you. What did you say? g I go to the ______________ frequently, but it is becoming a big ______________. I often wet myself. h I don’t ______________ if I took my medicine this ______________. 9 Which problems are these elderly people suffering from? Match the conditions in Exercise 2 with the speakers. Listen again to check your answers. a b c d e f g h 10 Read the text about mobility. Listen and complete the spaces. Assisting with mobility is an important role of the nurse in collaboration with (1) _________________. There are many reasons why elderly people have mobility problems. Some are related to physical problems such as (2) _________________ weakness after hospitalisation for example, or stiffness of the joints and pain from conditions such as (3) _________________ or rheumatism. Psychological factors are also involved. Fear of falling after an accident or (4) _________________, pain or fear of pain, foot problems that make walking (5) _________________, unsuitable shoes or even lack of motivation in people suffering from (6) _________________ are all motives for not moving around. There are practical solutions to many of these problems. The home should be reorganised so that the elderly person has solid objects to help them (7) _________________ and move around. (8) _________________ in the bedroom, bathroom and corridors will help both physically and psychologically. A tripod stick or (9) _________________ frame may also be helpful. It is important to have regular pedicures to cut long painful (10) _________________ and remove hard (11) _________________. Good shoes are fundamental. They must have rubber soles and be wide enough for comfort. If the elderly person has (12) _________________ feet with bunions, specialist shoes must be worn. Mobility is important for many reasons including healthy (13) _________________, muscle tone, respiratory (14) _________________ to encourage socialising and avoid isolation and (15) _________________. MY GLOSSARY pedicure n. 足部护理 bunion n. 大脚趾囊肿 Writing 11 Develop a short paragraph explaining the problems elderly people are likely to face in the process of aging. You can use the following hints: mobility problems difficulty using their hands memory problems sensory problems need help with daily tasks increased risk of falling joint replacement operations bed sores muscle deterioration depression osteoporosis obesity diabetes hypertension 12 Complete each sentence with a suitable word from this unit. 1) I can’t write because my hands _________________. (5-letter verb) 2) Hold the _________________ when you walk up stairs. (8-letter noun) 3) My _________________ have got bunions. They are very painful. (4-letter noun) 4) I am taking calcium supplements for _________________. (12-letter noun) 5) John can’t _________________. He’s deaf. (4-letter verb) 6) I need the support of a _________________ when I go shopping. (12-letter noun) 7) Where did I put my bank card? I can’t _________________. (8-letter verb) 8) Mary won’t go out. I think she’s _________________. (9-letter adjective) 9) I need new _________________ so I have an appointment with the dentist. (8-letter noun) 10) Frank doesn’t remember where he lives. He has got _________________. (8-letter noun phrase) Section 2 Diabetic Patient Care Starting Off 2 13 Read the comments. Do you agree? Why or why not? Macintosh HD:Users:adrienneharrison:Desktop:stock-photo-signs-of-diabetes-190809398.jpg Children drink too many sugary drinks and snacks. People are less active now and the problem of obesity is increasing. Diabetes only affects people over 60. Diabetes is not connected to obesity. It is related to insulin production. 2 Reading 14 Read the text and insert the headings in the spaces. Monitoring diabetes Difficulties of diabetes control in hospital Food management for diabetic patients Medication Diabetes in hospital A __________________________________ People with diabetes occupy up to 16% of hospital beds and nurses working in all hospital departments care for people with diabetes. They may have problems directly connected to diabetes or unrelated problems. Diabetes is part of a person’s life and must always be considered along with the presenting condition. Diabetes control is affected by illness, stress, changes in diet and activity levels. Healing processes are promoted by normal blood glucose levels, so good diabetes control is important to help the hospital patient recover quickly. Evidence shows that when diabetes specialist nurses work in collaboration with general nurses, the quality of care is improved and hospital time is reduced for diabetic patients. B __________________________________ Optimal finger-prick capillary blood glucose levels are 4–7 mmol/l. If the blood glucose level goes above 10 mmol/l, platelet function is impaired, healing is compromised and the risk of infection increases. In addition, hyperglycaemia will cause the person to experience uncomfortable symptoms of thirst, polyuria and blurred vision. Illness, stress and inactivity all produce hyperglycaemia so controlling blood glucose levels is difficult in hospital. C __________________________________ In hospital, diabetes is usually monitored by capillary blood glucose monitoring (CBGM) using a small metre. With regular testing the nurse can detect trends in blood glucose levels. Diabetes control can also be monitored by laboratory or by HbA1c if an overall picture of blood glucose control is required. D __________________________________ Most people with diabetes require medication. People with Type 1 diabetes need insulin therapy, and those with Type 2 diabetes may be on one or more oral hypoglycaemic agents. People with Type 2 diabetes may also take insulin to supplement their oral medication. Because the hospital stay can be stressful, increased doses of insulin or tablets may be necessary but the dose must be reduced before the patient leaves hospital. E __________________________________ People on insulin or sulphonylurea tablets are at risk of hypoglycaemia if they do not eat regularly. Eating on time, even in hospital, is important for this group. Those on other oral hypoglycaemics medication are not at risk of hypoglycaemia, but regular carbohydrate intake is important in order to regulate blood glucose levels. If patients eat a small amount of food during the day and a large evening meal, they will have a high blood glucose the next morning. MY GLOSSARY glucose n. 葡萄糖 optimal adj. 最佳的，最理想的 finger-prick capillary 指血采集 platelet n. 血小板 impair v. 损害；削弱 compromise v. 损害，危害；达不到 （标准）；妥协 hyperglycaemia n. 高血糖 症 polyuria n. 多尿症 blurred adj. 模糊的 insulin n. 胰岛素 hypoglycaemic adj. 低血糖症的 sulphonylurea n. 磺脲类药物 15 Find words in the text in Exercise 14 and match them with their definitions below. 1) high levels of blood glucose _____________________________________ 2) to become healthy again _____________________________________ 3) a desire to drink _____________________________________ 4) passing urine frequently _____________________________________ 5) quantity _____________________________________ 16 Read the text in Exercise 14 again and answer the questions. 1) What affects blood glucose levels in hospital? 2) Why is it particularly important to control blood glucose levels when a patient is in hospital? 3) What symptoms can hyperglycaemia cause? 4) What is used to measure diabetes control in hospital? 5) Why is eating regularly important? Listening 2 17 Complete the spaces in the text with words or phrases from the box. Then listen and check your answers. progressive heart attacks reducing production increasing injections destroys levels obesity 140/80 complications Type 1 diabetes is a result of an auto-immune process that (1) _________________ the beta cells of the pancreas. This results in limited insulin (2) _________________. The only treatment is daily (3) _________________ of insulin. In Type 2 diabetes insulin resistance increases blood glucose (4) _________________. This is usually in conjunction with (5) _________________, hypertension and hyperlipidaemia. Type 2 diabetes is primarily treated by (6) _________________ calorie intake and (7) _________________ physical activity, with the addition of oral hypoglycaemic medication and insulin, if necessary, to achieve good control. Type 2 diabetes is a (8) _________________ disease but good control of hyperglycaemia prevents or delays the progression of the long-term (9) _________________—diabetic retinopathy, nephropathy and neuropathy. In Type 2 diabetes, maintenance of blood pressure at (10) _________________ or below significantly reduces the risk of (11) _________________ and strokes. MY GLOSSARY beta cell （生产胰岛素的）贝 他细胞 pancreas n. 胰腺 conjunction n. 同时发生 hyperlipidaemia n. 高血脂症 retinopathy n. 视网膜病 nephropathy n. 肾病 neuropathy n. 神经病 18 Find words in the text in Exercise 17 and match them with their definitions below. 1) overweight condition _____________________________________ 2) high blood pressure _____________________________________ 3) low blood sugar _____________________________________ 4) high fat levels _____________________________________ 5) disease of the eye _____________________________________ 6) disease of the kidney _____________________________________ 7) disease of the nerves _____________________________________ 19 Listen to the information and complete the table below. 20 Look at the diagram. Listen to the nurse giving advice on living with diabetes and tick the things she mentions. Retinopathy Nephropathy Neuropathy _____________ impairment blindness _____________ glaucoma gradual _____________ damage kidney _____________ need for dialysis Peripheral neuropathy which leads to loss of function in the nerves, commonly of the _____________ and _____________. Proximal neuropathy affects the _____________ in the hips and buttocks. Autonomic neuropathy affects the control of body _____________ such as _____________, gastrointestinal function and vascular function. MY GLOSSARY glaucoma n. 青光眼 dialysis n. 透析 proximal adj. 近端的，近 侧的 Macintosh HD:Users:adrienneharrison:Desktop:stock-photo-diabetes-316154516.jpg 1) Don’t do too much physical activity as it is tiring for the body. 2) Try to eat less. 3) Check your blood glucose levels every day. 4) If you feel faint or tired, eat something containing vitamins. 5) If you notice that you urinate frequently, don’t worry. 6) Reduce the amount of salt you use. 7) Don’t drink too much alcohol. 8) Check your feet regularly for cuts or sores. 9) Go to a dietician who will advise you on what to eat. 10) Tell your doctor if you have any problems reading or focusing. 21 Listen again to the nurse in Exercise 20. Take notes. What does the nurse say about… 1) being overweight? __________________________ 2) diet? __________________________ 3) physical exercise? __________________________ 4) feet? __________________________ Macintosh HD:Users:adrienneharrison:Desktop:stock-photo-signs-of-diabetes-190809398.jpg Nursing and Society Hospice Care Sector Needs More Sustained Efforts for Development Hospice care, which had a relatively late start in China, is now seeing rapid development and strong momentum, but still needs more sustained growth efforts, experts said. Hospice care, which aims to tend to the physical, emotional and sometimes spiritual needs of the terminally ill patients and help them die with dignity, is now catching attention. Qin Yuan, director of the hospice ward at Beijing Haidian Hospital, said that currently, China’s hospice care service is developing rapidly. However, according to the World Health Organisation standards, many problems still remain. “Industry access standards, medication specifications, training courses and quality management systems are still under construction, and supporting monetary and regulatory policies are needed. In addition, the concept of hospice care, or using just enough medication to alleviate pain so that people can die in a gentle, dignified way, is not popularised enough in universal education. There is still a long way to go,” she said. Around 9 million people die in China every year, 75 percent of which are chronic deaths. However, only 20,000 people get palliative care, or hospice care, in institutions. Currently, there are more than 12 million totally disabled senior citizens in China. However, the average number of beds for hospice care in pilot hospitals is in single digit. The demand gap is huge. Jiang Mingyin, from the Yiyang Rehabilitation Nursing Care Centre in Beijing said that physicians, nurses, social workers, nutritionists, psychological consultants, and healthcare aids, are all involved in the hospice care process, in order to care for the patients physically, emotionally and spiritually. Relatives of the patients are also attended. In addition, universal education about hospice care is necessary. Life education should be included in the health curriculum of primary and secondary schools, so that the concept of hospice care can be widely recognised and accepted by the society. Discussion What benefits can hospice care bring to the terminally ill patients?