1. Unit three Instructions and procedure
Lesson four (Part one)
Unit three
Instructions and procedure

2. Introduction:
* In training environment ,doctors , nurses and other health professionals need to be able to give and receive instructions about how to perform a wind range of a procedure.
*However, working in hospitals as newly qualified /junior doctors or nurses ,you will be under supervision of senior doctors , nurses or professional people.
*perhaps you will be assigned to come with senior doctors to go on ward round , take some patients case history , writing up notes ,obtain consent to carry out the procedure for the patient . Sometimes they may ask the junior doctor or nurses to advice treatment or do some investigation.
* In such setting , It’s possible to be very direct and use the impetrative form of the verb the needle : Insert the needle ;wear the sterile gloves ;wash your hand , …..etc .This can be varied by adding the word you insert the needle …The imperative doesn’t sound impolite here , as each command forms a step which is part of an accepted the instruction like a formula.

3. Patient care (p.21-1) Introduce your self
consent
It’s legal requirement of the patient on particular treatment
or procedure. The consent may be necessary in writing .The patient has the right to know all risks ,benefits , and treatment before you undergo to any kind of procedure .The patient has the right to accept or refuse.
Introduce your self
It’s very important to the patient to put the patient at ease..The doctor may be wearing the name badge but the patient may not be wearing his or her glasses .the patient may not be able to read . E.g. Good afternoon ,Mrs….My name is……… and I am ………………..
Prepare the trolley
All the necessary equipment need to be present . A missing instrument in the middle of the procedure may cause problems.

4. What else you need to do before any procedure

5. p.21 - 2 1-Explain the procedure to the patient simply and clearly
2-Explain why it’s necessary.
3-what the procedure will be like for the patient
4-think about previous successful procedure you have done.
5-prepare the procedure by thinking through each step and use the process to check the equipment .
6-Decide whether you need and assistant .

6. Vocabulary : P.21-1

7. Lumbar puncture (LP)
Definition: Lumbar puncture, they remove a sample of CSF –cerebrospinal fluid from the spine .In which the needle is inserted to collect a sample of fluid for testing to
send it to laboratory.
*what does the LP show ?
 Infection of membrane surrounding the brain and the spinal cord.
 show the bleeding ,stroke
Meningitis
 tumors (cancers)

8. Explaining the lumbar puncture procedure:

11. First ,you prepare the equipment on the trolley
First ,you prepare the equipment on the trolley. Second, you should wash your hand thoroughly and put the sterile gloves . Next ,you will ask the patient to lie on with knees drawn to his chest .Then you sterilize the area of the patient back and inject the local anesthetic to numb the area .After that ,you mark the patient between L3/4 where the needle to be inserted . Once the needle has pierced the Dura mater ,you withdraw the stylet. After this, you attach the manometer to measure the pressure of the fluid. After you finish measuring it , you drain 10 drops of CSF into three specimen tubes .Finally ,you withdraw the needle while placing the pressure on the puncture site.

12. Language Spot Giving instruction:
- The imperative form of the verb can be used for giving clear and direct instructions.
positive
-wash your hand
-get out of bed
-complete the note
-listen
-put a plaster over
the wound
-Wear protective clothes
negative
-Don’t throw used items on the floor
-Don’t give the patient any fluid
-Don’t complete the note

13. Use always and never with the imperative to make instruction stronger
E.g. Always wash your hand
Always obtain consent from the atient before any procedure.
Always throw the used items in the trash bin .
Never take any drug before medical procedure.

14. - remember to take your medicine -don’t forget to come at 7.00 a.m
It’s common to use (Remember to +infinitive /Don’t forget to +infinitive)to give instruction.
E.g. .
- remember to take your medicine
-don’t forget to come at 7.00 a.m
-remember to inform your family
-Don’t forget to take your medication on time.

15. Explaining procedure:
-when you come to explain procedure ,we put “ you “ before the imperative.
e.g.
Wash your hand and put on your gloves .
apply pressure to the wound.
Note: while explaining procedure you need to use some words like: first ,second, next , then, before , after that , finally …..etc.
you
you

16. How to control external bleeding
First , you should apply pressure to wound .Second ,clean the wound with antiseptic .Next, when the bleeding is controlled , secure the dressing with a bandage .Finally , after the dressing is in place , don’t remove it to check the wound.

17. Adverbs :
- adverb is necessary in order to describe how action is done (-ly)
E.g Examine the patient carefully
- you clean the area thoroughly
- advance the catheter gently
-insert the needle slowly

18. IM injection ( Intramuscular injection)
Purpose : to insert a certain
drug in to the muscles .
Description :
-upper arm
-upper leg (thigh)
- hip (buttocks)

19. Instructions for this procedure:
1-first , ensure you have identified the patient and assist them into a position which is comfortable .
2-clean the site with alcohol swab
3-prepare the syringe by removing the needle cover, inverting the syringe and expelling any air.
4-spread the skin with your finger and inject the needle.
5-pull back the plunger a little .If you see blood enter the syringe ,pull the needle out and inject the medication, if you don’t see any blood simply inject.
6-pull the needle or withdraw it and dispose it in the sharp containers .
7-use the gauze to dab any blood ,cover it with a bandage.
8-wash your hand.

20. Speaking : p22-1

21. Wet hands and forearms under running water Take soap from dispenser

22. Soap up ,rubbing palm to palm Rub with finger interlaced

23. Rub with finger locked ,including finger tips
Massage between fingers ,right palm over back of left hand ,left palm over back of the right hand
Rub with finger locked ,including finger tips

24. Rub rotationally with thumbs interlocked
Rinse thoroughly

25. Dry hand thoroughly
Dispose of towel into foot operated pedal bin.Don’t re contaminated hands by touching the bin lid.

26. The end