ENG/NURSING2/ U1/BACKGROUND/1ST YEAR/2ND TERM/H.

RADWI

U1 Admission by A&E

Accident and Emergency (A&E) = Casualty

Triage:
- a word that comes from the French trier meaning ‘to sort’.
- to determine who is a priority and needs immediate treatment, and who can wait.
- Patients are color coded like this:

CATEGORY DESCRIPTION
Blue – dead or expected to die Patients who are so badly injured and will die soon
Red – immediate Patients could survive with immediate treatment (surgery or any life-saving action)
Yellow – observation Condition is stable for the moment but requires watching (hospital care)
Green – wait Patients who require a doctor’s care within hours, but not immediately
White - dismiss Patients who only require first aid and home care

Emergency medicine: Care of patients that require sudden and immediate action.

Emergency practitioner: gives immediate evaluation and treatment of people with acute injury and illness in a
hospital setting.

Emergency medical technician/paramedic: gives immediate care and transports sick or injured to medical facilities

An emergency is when a patient:

• has stopped breathing or their heart has stopped

• suffers severe chest pains or has trouble breathing (possible cardiac arrest)
• is bleeding severely
• is unconscious
• has had a serious head injury
• has a severe burn
• has a severe allergic reaction
• suffers numbness down one side (possible stroke)
• cannot understand what is said to them
• has a suspected broken bone of dislocation
• experiences severe stomach pains which do not go away when treated by over-the counter medicines
• has overdosed or poisoned themselves

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Ambulance equipments: (see Student’s Book, P4 for illustrations)

Ambulance chair – a light weight chair for transporting a patient to and from and ambulance

Bags of blood – plastic bags containing a range of blood types for transfusion

Bag-valve mask – a bag that fills with air, which you squeeze to force air into a patient’s lungs through a mask

Cardiac monitor - a machine for recording heart rate and blood pressure

Defibrillator – a machine that restarts a stopped heart by giving a controlled electric shock

Drug box – a box containing a range of life-saving drugs and equipment for administering them

IV pump – a machine for pumping liquids or medication into the body through a vein

Oxygen cylinders – oxygen for use with a mask for patients who are not breathing, or not breathing effectively

Oxygen regulator – a device that controls the flow of oxygen from a cylinder into a patient’s oxygen mask

Ramp – a slope that allows a stretcher or wheelchair to be pushed up into a vehicle, building, etc.

Stretcher – a flat surface used for lifting and transporting a patient who is lying down

Suction unit – a tube and electric pump for removing unwanted fluids from the body, e.g. from the lungs

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ENG/NURSING2/ U2/BACKGROUN/1ST YEAR/2ND TERM/ H.RADWI

U2 Admission by Referral

Elective admissions: when people are admitted to hospital through referral by outpatients departments or
outside doctors.

Inpatients: patients who stay in hospital overnight or longer for treatment or observation.

Outpatients: (students search)

- Most hospitals are made up of wards that specialize either … or:

 in types of patients such as paediatrics, geriatrics, etc.

 in groups of illnesses such as oncology, infectious diseases, etc.

- Patients/staff communication is very important.

- Patients must give their informed consent for any medical procedure.

- Hospitals develop:
 own systems of recording
 own forms and questionnaires
 own sets of abbreviations

- Medical notes are often indecipherable to outsiders:

 tragic consequences when written records were not clear
 attempts to simplify and standardize records of care and make them more transparent

- Jargon: (students search)

- Medical slang:
‘FTF’: Failure to fly (attempted suicide victims)
‘Obs and Gobs’: Obstetrics and Gynaecology
‘Scepticaemia’: what medical staff develop as they get experience

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U3 Obstetrics

Obstetrics: branch of medicine and surgery dealing with pregnancy, childbirth, and the period immediately after childbirth.

Obstetrician/Gynecologist: (students search)

Midwifery: study of practical aspects of obstetrics

Midwife (pl. midwives): (students search)

Antenatal = before birth (ante- = before nat/i = birth)

Post-natal = after birth (post- = after)

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Pregnancy: 40 weeks gestational period divided into thirds called trimesters.

Trimesters:

1) The first trimester: first 14 weeks.

The expectant mother (mother-to-be) may experience:

- morning sickness,
- mood swings
- food cravings
- (nausea?):

Risks:
 A miscarriage:
 An ectopic pregnancy: when the fertilized egg attaches outside the uterus (Womb)
(ec- = out, outside)

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2) The second trimester: 14 – 28 weeks of gestation

Most common problems:

 Incompetent cervix: when the cervix does not stay closed, it dilates and there is a premature delivery.

Incubator: (students search)

Neonatal ICU: (students search)

3) The third trimester (safest period of pregnancy): 28 weeks – delivery

The expectant mother may experience: backache, mild urinary incontinence, and heartburn.

Problems:
 Pre-eclampsia:
- a disease caused by toxins secreted by the placenta.
- It results in high blood pressure and
- in severe cases it can lead to convulsions and sometimes death.

During pregnancy:
- woman’s plasma & blood volume increase up to 50% which results in  increased heart rate, blood
pressure, and white blood cell count.
- Also changes in metabolism: increase in kidney size, and alterations to the chemical composition of the
body.

Antenatal monitoring process:

- Routine physical exam
- Tests such as: ultrasound scans, percutaneous umbilical blood sampling

Percutaneous umbilical blood sampling:

P lacing a needle through the abdomen into the uterus to extract a piece of the umbilical cord for analysis.

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Types of labour:
- Natural birth using no aids
- Using aids to assist labour such as: forceps, pain relieves
- Caesarean section

Pain relieves provided during birth (labour):

- Nitrous oxide
- Opiates
- Epidural anasthesia

(The mechanism of labour)

If a woman does not give birth by 41-42 weeks. Labour will sometimes be induced.

What is an abortion?
Abortion: (students search)

Two types: spontaneous and induced

www.childbirth.org
www.midwivesonline.com/midwives/forum
www.pregnancy.org/pregnancy/FirstTriExperts/php
http://tinyurl.com/yr84cf
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ENG/NURSING2/ U4/BACKGROUND/1ST YEAR/2ND TERM/ H.RADWI

U4 Pharmacy
Pharmacy: 1. The preparation and dispensing of drugs. (2. Premises registered to dispense medicines)
Pharmaceutical (farm-a-SEWT-ikal): adj. relating to pharmacy.
Pharmacist: a person who is qualified by examination and registered and authorized to dispense medicines.
[pharmaco- = drugs]
Pharmacology (farm-a-KOL-oji): the science of the properties of drugs and their effects on the body.
( Related Terminology: Pharmacologist (n.), pharmacological (adj.), pharmacodynamics, pharmacokinetics, . . . )

One hundred years ago:

- major killing diseases: diphtheria, chickenpox, scarlet fever, rubella, gastrointestinal diseases,
pneumonia, measles, tuberculosis, syphilis, meningitis, and so on.
- For curing illnesses they used: quinine, plant-based purgatives, digitalis, and mercury (often ineffective
and dangerous)

Advanced medicine:

Examples of medicines grouped according to the condition they target:

• Analgesics: kill pain
• Antibiotics: fight bacteria
• Antidepressants: for changing mood
• Antihistamines: fight allergies
• Antihypertensives: lower blood pressure
• Anticoagulants: prevent blood clotting
• Antiarrhythmics: control irregular heartbeat
• Anti-inflammatories: reduce inflammation
• Diuretics: rid the body of excess fluids
• Hypoglycemic: lower the level of glucose in the blood
• Immunosuppressives: prevent the body from rejecting organ transplants
• Laxatives: increase bowl movements
• Sedatives: suppress anxiety and relax the muscles
• Vitamin supplements: for inadequate diet and digestive disorders

Student nurses are trained in mathematics:

 to ensure safe working practices with them.
 to calculate dosages of tablets, fluids, and IV rates such as:
formulae, fractions, decimals, percentages, ratios, proportions, and conversions.

Drugs are tested before going on to the market.

Randomized controlled trials:
Double-blind procedure:
 Involve the random allocation of drugs to trial participants.
 Neither the researcher nor the patient knows the details of the treatment.
 They don’t know who is getting the drug and who is getting a harmless substitute.
 Placebo effect: (harmless substance given as medicine esp. to humor a patient)

www.lanpdc.scot.nhs.uk www.testandcalc.com www.icp.org.nz.

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U5 Ophthalmology

[ ophthalm/o = eye -logy = study of ]

Ophthalmology (of-thal-MOL-o-ji): Study of eye; the diagnosis and treatment of eye disorders.
Ophthalmologist: Specialist in the study of the eye and the treatment of eye disorders.
Optometrist / optician = Nonmedical specialist who prescribe optical aids like: glasses, corrective lenses
(Related Terminology: ophthalmoscope, ophthalmoscopy)

The eye is a tiny assembly of:

 light sensitive cells
 adjustable lens and diaphragm
 nerves: transmit impulses to the visual cortex of the brain.

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Eye disease: most common forms of ill health, particulary in the elderly
Problems with the visual pathway ( eye, brain, eyelids, and lacrimal system which protect the eye)

Glasses are prescribed when light rays do not focus correctly on the retina.

Short-sightedness = myopia:
 when light rays focus in front of the retina
 treated by:
 a concave lens
 surgically (excimer laser)

Long-sightedness = Hyperopia (hypermetropia):

 when light rays focus behind the retina
 treated by a convex lens

Presbyopia:
- the loss, through ageing, of the eye’s ability to change focus
- people develop in mid 40s lens lost too much flexibility

Laser surgery:
- Used in operation on the cornea for correcting myopia (excimer laser)
- Not able to treat age-related presbyopia.

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The work of an Ophthalmology department includes the following:

• Extracting cataracts and replacing the natural lens with a plastic intraocular one
(intra- = within ocul/o = eye)
• Laser surgery:
a) to change the shape of the cornea
b) to reduce dependence on glasses
c) to decrease internal pressure for the treatment of glaucoma = trabeculoplasty
( -plasty = surgical repair)
d) Used for cutting tissue for photocoagulation of the retina
• Surgery on the extra-ocular muscles to treat strabismus.
Strabismus = cross eye (= squints): when eyes do not align correctly
• The excision of tumors on the eyelid and in the eye
(excision = -ectomy)

Ophthalmic nurses:

 Examine and advise patients

 Administer tests for visual acuity
 Do slit lamp examinations
 Test blood pressure and urine
 Make preliminary diagnoses
 Assist ophthalmologists in surgery
 Treat cataracts with surgery = laser capsulotomy ( -tomy = incision, process of cutting into)
 Excise cysts in the eyelid
 Other minor surgical procedures

http://tinyurl.com/2auze9

www.michaelbach.de/ot/.

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U6 Dermatology
[ dermat/o, derm/o = skin -logy = study ]

Dermatology (der-mah-TOL-o-je): Study of the skin and its diseases; diagnosis and treatment of skin disorders
Dermatologist: physician specializing in the skin and its diseases.
(Related Terminology: dermal, dermis, dermatitis, dermatosis, debridement)

The skin:
• Largest body organ
• It’s color and texture give information about the genes
• Its secretions generate a scent
• It is the medium by which humans make contact with their environment
• It plays an important protective role
• It synthesize vitamins and regulate temperature

Problems:
Internal problems:
- Pimples on the face may be too much sugar in the diet
- Yellowish skin may be a sign of liver and pancreas disorders or anemia

Treat many skin problems by correcting physiological imbalances.

Common skin conditions:

 dermatitis
 eczema
 psoriasis
 urticaria (hives)
 acne
 keratosis ( = hardening of the skin)
 canker sores: characterized by itchy, red skin eruptions = erythema (redness)

Burns:
- a common concern of Dermatology,
- are graded according to how many of the three layers of skin are damaged:
 A first-degree burn involves only the epidermis
 A second-degree burn involves the dermis
 A third-degree burn affects the subcutaneous layer

Treatment of serious burns:

o Artificial skin
o Skin graft:
- graft skin from another part of the body on to the burn.
- without grafts scarring, disfigurement

(psychological & social problems) usually addressed by dermatology nurses

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Cosmetic dermatology

Graft
Laser surgery
Photomedicine: uses ultraviolet light
Topical treatments: e.g. creams
Beauty products
Antibiotic
Steroid ointments
Treatments for malignant melanoma (skin cancer) such as:
 imiquimod cream: enhances the immune system

This case history illustrates the context and work of a dermatology nurse.

‘an 18-year old girl had been asleep when a fire started in the living room below her bedroom. She was rescued
and admitted for third-degree burns. When she was brought in, she was unconscious and deteriorating from
circulatory failure. Nurses closely monitored her unstable vital signs and she regained consciousness the
following morning. A topical antibiotic was applied followed by a plastic epidermal graft.
The patient began a long, slow recovery. A nurse had to change her position in bed every two hours to prevent
the formation of bedsores. She lost a lot of weight over the following three weeks, despite nasogastric tube
feeding (see illustration below). Starting at nine weeks, sheets of cultured skin cells were grafted to her
regenerating dermal layer and by the fifteenth week of her hospitalization, the grafts were complete. The
patient was back on solid foods, antibiotics were discontinued, and she was discharged with a rehabilitation
plan for occupational therapy at home and twice-weekly visits by a nurse.
During the initial home visit, the nurse found the patient very tearful and upset about her appearance. She was
in fact only slightly scarred, but she was very embarrassed and would not leave the house for fear that people
would stare. The nurse had to find practical solutions to the patient’s cosmetic needs as well as reassuring her
and encouraging her to feel more positive about her face.’

Physical medicine and rehabilitation: treatment to restore function after illness

Physical medicine and rehabilitation specialist: (students search)
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U7 Oncology

[ onc/o = tumor -logy = study ]

Oncology (ong-KOL-o-je): Study of tumors

Oncologist: Physician specializing in the study and treatment of tumors (benign & malignant)

Cancer: is the uncontrolled spread of abnormal cells (tumors) which destroy other tissues through a process
called metastasis. [ meta- = change -stasis = place ]

There are two kinds of tumor: [ -oma = tumor, mass, swelling ]

- Malignant: cancerous and life-threatening
- Benign: not cancerous or life-threatening

There are different types of cancer and they are classified by:

1- the type of tissue in which the cancer originate:

• Carcinoma (glands internal organs) [ carcin/o = cancer, cancerous ]
• Sarcoma (bone, cartilage, fat, muscle, and blood vessels) [ sarc/o = flesh ]
• Myeloma (plasma cells in bone marrow) [ myel/o = bone marrow ]
• Leukaemia (white blood cells) [ leuk/o = white]
• Lymphoma (nodes of the lymphatic system) [ lymph/o = lymph ]

2- the part of the body where the cancer first develops:

• breast cancer [ mast/o = breast ]
• lung cancer [ pulmon/o, pneumon/o = lung ]
• skin cancer [ derm/o. dermat/o = skin ]
• prostate cancer [ prostat/o = prostate gland ]
• colorectal cancer (the bowels) [col/o = colon rect/o = rectum]

Medical specialists who are involved in the diagnosis and treatment of cancer include:
[oncologists, pathologists, physiotherapists, counselors, geneticists, and nurses trained in palliative care]

Diagnosis of the disease is done by:

 biopsies
 endoscopies
 scans and x-rays
 positron emission tomography
 blood tests

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Remission: is when cancer shrinks.

- Complete remission may mean that a patient is cured, although it may return.
- Partial remission almost always return.

Treatment:
 Chemotherapy:
- by powerful drugs
 Radiotherapy:
- by radiation given in the form of x-rays which kill cancer cells
- It is painless and given in fractions.
Fractions: a course of treatment over days or weeks in sessions.
 Hormone therapies:
- by stopping hormones getting to cancer cells.
- Types of cancers which respond to hormone therapies: breast cancer, prostate cancer
 Surgery: excision of the affected part(s)

Chemotherapy & radiotherapy side effects:

o Nausea and vomiting
o Hair loss
o Fatigue
o Bone marrow depression
o Low white blood cell count

Cancer is caused by a number of factors in combination:

• Exposure to a carcinogen such as:
 Tobacco
 derivatives of coal tar
 radiation
 asbestos
 arsenic
 The sun
• Genetic predisposition to cancer
• Poor diet
• Problems with the immune system

Ethical issues recur in oncology:

- The issue of truth telling – what and how much to tell a patient about their illness.
- The issue of the participation of terminally ill people in clinical trials
- The issue of whether one has a right to withdraw treatment and use ‘do not resuscitate’ instructions

Radiology: diagnosis using x-rays and other procedures (ultrasound & magnetic resonance imaging MRI)
Radiologist: (student search)
Radiation oncologist: (student search)
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U8 Gastroenterology
[Gastr/o = stomach enter/o = intestine -logy = study of]

The word gastroenterology comes from two Greek words: gastros = stomach, enteron = intestine

Gastroenterology (gas-tro-en-ter-OL-o-je) = the study of the stomach and intestines.

Gastroenterologist: specialist in the treatment of stomach and intestinal disorders.
Related Terminology:
(Gastric - Gastritis - gastroenteritis - gastrectomy - gastroscope - gastroscopy - gastrotomy - gastralgia)

Hospital gastroenterology departments deal with illnesses of :

The digestive system or gastrointestinal (GI) tract:

 a long hollow tube about 6.5 meters long going from the mouth to the anus
 joins a string of organs including the: (see illustration below)
oesophagus, stomach, small intestine, liver, gall bladder, and pancreas
 divided into: the upper tract and the lower tract (= the upper and lower bowels)
 very vulnerable: constantly exposed to material coming from outside the body.
 The entire body is connected to the digestive system and when it has problems, the rest of the body will
suffer badly.
 Illnesses of the digestive system range from:
mild problems: indigestion and diarrhea life-threatening conditions: colorectal cancer

Food enters the body via the mouth

and travels through the pharynx,
esophagus, and stomach to the
small intestine (duodenum).
The liver, gallbladder, and pancreas
make and store chemicals that aid in
the digestion of foods.
Digested (broken down) food is
absorbed into the bloodstream
through the walls of
the small intestine (jejunum and ileum).
Any food that cannot be absorbed
continues into the colon (large intestine)
and leaves the body through the rectum and anus.
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The most common problems of the gastrointestinal tract are:

• Inflammation of the oesophagus (oesophagitis)

• Infections of the stomach and intestines caused by viruses, bacteria such as E. coli, or by parasites
• Appendicitis: most common in children and teenagers
• Ulcers caused by the bacterium Helicobacter pylori
• Inflammatory bowel disease ( = ulcerative colitis + Crohn’s disease)
• Celiac disease: a disorder where people have difficulty digesting the nutrients from their food
• Irritable bowel syndrome, which affects the colon and for which, at the moment, there is no cure
• Cystic fibrosis: a blockage of the pancreas
• Hepatitis: inflammation of the liver
• Cholecystitis: inflammation of the gallbladder (gallstones)
• Bowel, liver, and stomach cancer.

Testing for diseases of the GI tract is done by:

 Taking a throat swab

 Collecting faeces for analysis
 Getting a sample of blood
 Ways of looking into the GI tract:
 Endoscopy and flexible sigmoidoscopy:
Pushing into the GI tract a long tube with a camera on the end which produces images on a screen
to see inflammation, blockages, and impaction.
 X-rays enhanced by using barium enemas:
Putting liquid barium into the body via the rectum.
Enemas (normally administered by nurses):
A way of cleaning out the bowels and it can be a route for medication
 Capsule endoscopy:
Patient swallow a tiny camera and it takes pictures as it makes its way through the bowels.

Gastroenterology nurses:
 carry out tests in the process of diagnosing illnesses and screening for colorectal cancer.
 have to address practical issues which patients face concerning: faeces, smells, flatulence, and excretion
with useful and clear advice.

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U9 Neurology

[ neur/o = nerve -logy = study ]

Neurology (nu-ROL-o-ji): Study of the nervous system and nerve disorders.

Neurologist: Specialist in the diagnosis and treatment of nervous disorders.
Neurosurgeon: Physician who operates on the organs of the nervous system (brain, spinal cord, and nerves)
Nervous system: organs (brain, spinal cord, and nerves) that transmit electrical messages throughout the body
[Related Terminology: neural, neuritis, neuropathy, neurotomy, . . . ]

Human brain:
- built around nerve cells called neurons Neurology
- processes emotions
- generates hormones
- deals with:
reasoning
language
autonomic functions (not under conscious control) such as:
 sweating
 breathing
 digestion . . . etc.

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Neurology deals with medical problems that include:

• Headache disorders like migraines ?

• Sleep disorders
• Speech and language disorders
• Comas
• Cerebral palsy ? [cerebr/o = cerebrum -al = pertaining to (adj.)]

• Traumatic injuries to the brain and spinal cord [encephal/o = brain]

• Tumors of the brain or spinal cord. (see illustration below)

• Tic disorders such as: Tourette syndrome ?
• Cerebrovascular illnesses such as: strokes
• Degenerative illnesses such as: Alzheimer’s disease and Parkinson’s disease ??
• Diseases of the central nervous system such as: multiple sclerosis ?
• Infections such as: encephalitis

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‘brain’ and ‘mind’ cannot be separated Neurology department overlaps with Psychiatry
Many mental illnesses are thought of as neurological disorders such as: bipolar disorder ? (students search)

Neurologists test patients to assess brain activity.

Neurological tests: a range of sophisticated equipment and procedures

 Neuroimaging
- includes magnetic resonance imaging (MRI) and electroencephalograms
- allows for close examination of brain activity.

 Other tests assess:

- vision
- strength
- co-ordination
- reflexes

Traumatic brain injury:

- very common especially in children
- symptoms vary: mild concussion deep unconsciousness or coma
- Glasgow coma scale (GCS):
measure the level of consciousness.
Eye, verbal, and motor responses are assessed and recorded
e.g. a patient brought in with a head injury Glasgow coma scale is used

Comas:
- depend on the degree of neurological damage (could last for decades)
e.g. a comatosed state: a patient may talk and walk around
- Patients: either gradually come out of a coma
or pass into a vegetative state
or die

Euthanasia: The question of whether ?

- to keep someone artificially alive plugged in to machines providing long-term life support
OR
- switch off and allow death to come naturally.

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U10 Coronary

[ coron/o = heart -ary = pertaining to (adj.) ]

Coronary (KOR-on-ary): Pertaining to the heart.

Coronary arteries: Blood vessels that carry oxygen-rich blood from the aorta to the heart muscle.
Cardiac (KAR-de-ak): pertaining to the heart.
Cardiology (car-de-OL-o-je): study of the heart.
Cardiologist: physician specializing in the study of the heart and heart diseases.
Cardiovascular surgeon: specialist in operating on the heart and blood vessels.
( Related Terminology: angiography, angioplasty, cardiomegaly, cardiomyopathy, . . . )

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Coronary heart disease:

o kills one in four men and one in six women

o a silent disease (rarely noticed until it is well advanced; no apparent symptoms)
o in the early stages of the illness: tests (like coronary angiograms) may not show any signs of the illness
o over time, the atheromatous deposits increase and slow up the flow of blood
o examples of coronary heart diseases:
 Atherosclerosis:
when the blood supply to the heart is blocked in the arteries by fatty deposits ( = atheroma)
 Atherosclerosis leads to angina ( = chest pain) [see illustration below]
 Angina can cause a heart attack = myocardial infarction (medical term)
Heart attack:
- causes heart muscle damage (at best)
OR
- kills (at worst)
 Ischemia and a sudden heart attack:
Limited blood flow to the heart, caused by narrowing of blood vessels. [see illustration below]
 Cardiac arrest: hearts that actually stop
 Arrhythmias: abnormal rhythms of the heart

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Risk factors of coronary heart disease: related to lifestyle, and sometimes a genetic predisposition to the disease
• High blood cholesterol ( = Hypercholesterolemia) acquired through:
diabetes and kidney disease
poor diet
obesity
lack of physical activity
[ hyper- = excessive, too much -emia = blood condition cholesterol: (student search) ]
• High blood pressure: thickens the walls of the arteries and makes them narrower
• Smoking:
raises blood pressure
increases the tendency for blood to clot
• Type A personality characterized by:
Impatience
Competitiveness
Aggressiveness

Medical treatments:

 when someone has a heart attack, they are given:

o oxygen through a face mask
o nitroglycerine: to improve blood flow
o morphine: to kill the pain
o aspirin: to inhibit blood clotting

Then they may receive:

o an emergency angioplasty: a long thin tube passed into the artery at the tip of which is a balloon
which is inflated when everything is in place.
The balloon: opens up the artery, allowing the blood to flow more freely.
A stent (a small spring-like device) is then inserted: holds the artery open
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 People with severe coronary heart disease:

Revascularization = coronary artery bypass grafting (CABG)
o Done by:
- opening up the chest wall
- grafting on a blood vessel taken from the patient’s leg
- positioning of new blood vessel to carry the blood around theobstruction
o This surgery has a low rate of complications
o Frequently done by keyhole surgery

The cost of treating heart disease:

- Very costly
- One way to reduce the cost is to cut hospital admissions for treatment, care, and rehabilitation by:
 early screening
 have patients see a nurse at home
The nurse:
 evaluates their condition
 reiterates the basics of heart failure – its causes and prevention.

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U11 Surgery
[ surg- = hand]
Surgery: the branch of medicine that treats injuries, deformities, or disease by operation or manipulation.
Surgeon: a qualified medical practitioner who specializes in surgery.

Surgery is mostly about cutting and removing.

In the past, surgery was limited to: limb amputations and the removal of growths.
Surgery has always been risky. Even with modern anesthetics, blood transfusion and antiseptics, patients may
die from:
- complications such as: the trauma of pain, loss of blood, and infections.
- other dangers such as:
 bad reactions to anaesthetics
 problems with wound healing
 deep vein thrombosis
 dehiscene ( = the splitting open of a surgical wound)
 lung risks & heart problems (depending on the state of health of the patients)

[ -otomy (= -tomy) : surgical incision into an organ or a part ]

Surgical procedure ending in -otomy:
• Episiotomy: enlarging the vagina to assist in birth
• Gastrotomy: incision in the stomach
• Laparotomy: insicion of the abdomen
• Lobotomy: an operation on the frontal lobe of the brain An incision (cut)
• Tracheotomy: an incision is made into the trachea through the neck.
• Nephrotomy: cutting into the kidney

(episio- = the vulva gastr/o = stomach lapar/o = abdomen nephr/o = kidney )

[ -ostomy (= -stomy): surgical opening into an organ or part ]

Surgical procedure ending in -stomy:
• Tracheostomy: making a hole in the throat to the trachea
• Oesophagostomy: making a hole in the chest to the oesophagus
• Colostomy: opening of the colon to the outside of the body
( trache/o = trachea oesphag/o = esophagus col/o = colon; large intestine )

[ -ectomy = excision (removal); process of cutting out ]

Surgical procedures ending in -ectomy involve removing things. Some operations such as:
• Appendectomy: removal of the appendix
• Cholecystectomy: removal of the gall bladder
• Lumpectomy: removal of a lump in the breast
• Mastectomy: removal of all or part of the breast
• Hysterectomy: removal of the uterus
• Tonsillectomy: removal of the tonsils
• Vasectomy: removal of part of the vas deferens (sperm tube)

( append/o, appendic/o = appendix cholecyst/o = gallbladder hyster/o = uterus

lump = swelling, tumor; hard mass mast/o = breast tonsil/o = tonsils vas/o = vas deferens )
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Plastics make it possible for surgery to rebuild and restore.

[ -plasty = surgical repair; surgically changing the shape ]
Surgical procedures ending in -plasty:
• Abdominoplasty: changing the shape of the abdomen
• Angioplasty: the widening of a blood vessel
• Dermatoplasty: plastic surgery of the skin
• Mitral valve plasty: a repair of the heart
• Tympanoplasty: changing the shape of the eardrum
• Z-plasty: improves the appearance of scars
( abdomino = abdomen angi/o = vessel (blood) dermat/o, derm/o = skin tymphan/o = eardrum )

Minimally invasive procedures performed by surgeons: expanding by the aid of fiber optics and computers.
Keyhole surgery: viewing what is going on inside the body

Such procedures end in -oscopy (= -scopy): optical examination; process of viewing or visual examination.
Procedures ending in -oscopy:
• Endoscopy: (process of viewing the inside of hollow organs or cavities)
• Gastroscopy: optical examination of the stomach
• Hysteroscopy: to diagnose uterine disorders (visual examination of the uterus)
• Colonoscopy: to examine the colon (optical examination of the colon)
• Bronchoscopy: to examine the lungs

( end/o = within, in, inner colon/o = colon bronch/o = bronchial tube )

[ -centesis = surgical puncture in order to drain off fluid or air; surgical puncture to remove fluid ]
Procedures ending in -centesis:
• Amniocentesis: Draining fluid from the amniotic sac (sac that surrounds the embryo)
• Arthrocentesis: draining fluid from a joint
• Thoracocentesis: surgical puncture of the chest to remove fluid
(amni/o = anmion arthr/o = joint thorac/o = chest )

Scrub (theatre) nurses:

- Work in surgery
- Responsible for sterilizing equipments
- Ensuring that the operating environment is aseptic
- Pre-operative duties:
 Preparing patients for surgery by following site surgery protocols
 Getting information about allergies
 Compiling pathology results, and images.
- In the operating theatre:
 Assist by anticipating what the surgeons are going to do next
 Watching over the patient, checking for complications
- During the crucial post-operative recovery period:
 Monitor patients very closely

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Surgical Procedures

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Surgical Procedures

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Surgical Procedures

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Surgical Procedures

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Surgical Procedures

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Instruments (equipments) used in Surgery

Suction Catheter High Vac Suction Units

An implant An Implant Microchip

a Dental implant

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Retractors

Surgical clamp surgical clamp

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Tissue Forceps

bone forceps

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Surgical Suture

Suture

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surgical staples strip of staples

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U12 Infectious Diseases

Infectious diseases: diseases caused by pathogens
Pathogens: viruses, bacteria, fungi, protozoa, and proteins (called prions)
The word infection is used:
- in relation to infectious diseases
- to mean the spread of pathogenic micro-organisms in an individual e.g. an infected wound

Infectious diseases can be classified:

by their means of transmission
by the area of the body they attack

Examples:
Tuberculosis: a respiratory disease transmitted through airborne droplets spread by sneezing and spitting.
Hepatitis: a gastrointestinal disease acquired through contaminated food and water.
Syphilis: a sexually transmitted disease travels to a new host via bodily fluids and possibly pick up meningitis
Meningitis: an inflammation of the brain and spinal cord by touching a contaminated object (e.g. a doorknob)

according to the type of pathogen that causes them:

o Primary pathogen:
- can bring a disease in a healthy host
- responsible for illnesses such as: HIV, malaria
o Opportunistic pathogens:
- cause diseases in hosts with depressed resistance
- thrive on hospital wards
- responsible for hospital acquired diseases such as: MRSA, C. difficile

Hospital acquired diseases are of major concern to hospitals because:

- The pathogens that cause them are always present
- They are carried in the noses and on the skin of healthy people.
- They are very difficult to get rid of and can persist for months on surfaces, in spite of
standard cleaning procedures.

Identifying an infectious disease:

- Close examination of a patient
- Culturing of infectious agents taken from the patient
Cultures: examined under microscope and matched against known agents
- Scans and x-rays: find clues in internal abnormalities caused by pathogens

Pathogens don’t intend to kill their hosts.

If the host lives, pathogen is cleared out of the system and the symptoms fade. (because of the immune system)

The immune system reacts to the presence of pathogens and has mechanisms that kill invaders.
Antibodies and lymphocytes also provide immunity from further infection.

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Immunity:
Innate: immunity acquired as a result of disease
Vaccination:
- Immunity gained by introducing a disease to the body to evoke a response by the immune system to
protect the body from harm.
- Has two uses:
 Immunize people who have not contracted a disease
 Treat people who have recently been infected
(first rabies injection: given to a child bitten by a rabid dog)
- Vaccine triggers a quicker immune response than a natural infection.
- Vaccination campaigns save many lives.

Q: Why pandemic (global epidemics) diseases like: [cholera, smallpox, typhoid, dysentery] have disappeared
from many regions?

A: 1. Better hygiene and clean water (main reasons)

2. Vaccination campaigns

According to WHO (World Health Organization), millions of people die every year in poor countries from
preventable diseases.

(Infectious disease specialist: A doctor who diagnoses and treats diseases that are caused by microorganisms.
Physician who treats disorders caused by microorganisms such as bacteria.)

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U13 Renal
[ renal (RE-nal): pertaining to the kidney ren/o = kidney ]
Renal refers to the kidney
Nephrology (neh-FROL-o-je): The branch of medicine which specializes in kidneys.
Study of kidney and its diseases.
Nephrologist: Specialist in the diagnosis and treatment of kidney diseases.

Nephrons:
- the basic functioning parts of the kidney
- tiny tubes that:
 filter blood
 control blood pressure
 excrete waste in the form of urine

Kidneys are essential to life. If they fail, medical conditions will exist:
• Uraemia: body fills with extra water and waste products then poisoned.
• Renal failure:
- common causes: diabetes, high blood pressure (hypertension)
- treatment:
 Dialysis: (sustains life temporarily)
o Artificial filtering of blood
o Two major forms:
 Haemodialysis:
Blood is taken out of the body, passed through a filter, and
returned clean
Done by a dialysis machine at a renal unit every other day
 Peritoneal dialysis (PD):
Putting a fluid into the abdomen: this fluid captures waste products
and is drained away after a few hours.
Done at home, four times a day (several times a day)

 Kidney transplant (not a complete cure for renal failure)

o To transplant a healthy kidney into someone suffering renal failure.
o The old kidneys are left in place and a donor kidney is put in next to them to take
over their work.
o The donor kidney has to match the recipient in: blood type and size.
o When a kidney is transplanted, the recipient’s immune system identifies it as
foreign body and tries to reject it.
o To suppress the immune system form rejecting the donor kidney: medicines
have to be taken for the rest of a patient’s life.
o According to studies, a transplant recipient will live 10-15 years longer with a
kidney transplant than if kept on dialysis (endless cycle of treatment).
o Few people object to transplant on religious grounds.
o Main ethical questions:
 Who gets one? (never enough donor organs for everyone who needs one)
 Who has the right to decide to use the organs of a potential donor? (who is
either dead or unconscious)
Renal nurses:
 Provide emotional support
 Educate patients to change diet (reduce intake of proteins, sodium, potassium) and lifestyle
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U14 Psychiatry
[ PSYCH/O = Mind IATR/O = Treatment ]

Psychiatry (si-KI-ah-tre): Treatment of disorders of the mind. (emotional maladjustments)

Psychiatrist: Specialist in the treatment of the mind and mental disorders.
Psychology: Study of the mind, especially in relation to human behavior.
Psychosis: Abnormal condition of the mind; a serious mental disorder that involves loss of normal perception of
reality. (pl. psychoses)

Mental illnesses: a disorder of one or more of the functions of the mind, which causes suffering to the patient or
others.
Mental illnesses is broadly divided into:
Psychosis: in which the capacity for appreciating reality is lost.
Neurosis: in which insight is retained.

Mental illnesses include:

 Anxiety disorders such as: phobias, compulsions, obsessions
 Psychotic disorders such as: schizophrenia
 Eating disorders such as: anorexia
 Developmental disorders such as: autism
 Personality disorders such as: paranoia, psychopathy [ -pathy = disease condition]

Sigmund Freud’s psychoanalysis:

- Influenced the way we think about ‘madness’ and neurosis.
- Pointed to the role of childhood experiences in emotional disorders.

In the past, schools of thought championed the correctness of their own philosophies.
- The evolutionists view:
Mental illnesses is the result of our impulses and behavior that have developed over millions of years,
colliding with the demands of modern civilization.
- The biogenic view:
Mental illness is down to brain damage, especially when incurred during pregnancy and birth.
- There is also a view:
links certain viruses with brain damage and psychiatric problems

These days psychiatry has a more all-embracing view:

- Biopsychosocial view: That the causes come down to three things:
o Genes
o Environment
o A combination of the two

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Assessment and diagnosis of mental illness: done by observation and tests

- Interview the patient and collect the views and accounts of relatives and others
- ‘Projective’ tests: patients project their feelings on to the stimulus and reveal their motives, needs,
defence (defense) mechanisms, irrational thinking, and perception of themselves.
 Psychological tests:
Algorithms – ticking off a list of diagnostic criteria (by the tester)
 Personality tests: giving the patient a stimulus as a picture and asking them to react to it.
e.g. by making up a story based on it.
Rorschach ink blot test: one of the best known

Treatment for mental illnesses:

- Varied
- Complete cures are still rare
- Depends on:
o a patient’s problem
o the money available
o the philosophy of the therapist delivering the treatment
- Biomedical therapies: drugs such as:
 antidepressants
 mood stabilizers
 anti-psychotics
- Electroconvulsive therapy (ECT)
- Humanistic therapies:
look at the mismatches between the ‘true self’ of a patient and the self which is presented to others.
- Cognitive therapies:
based on the view that mental illness is the result of the irrational ideas people have about themselves
and the world they live in. They replace negative thoughts with positive ones.
- Behavior therapy:
sees problems in terms of maladaptive behavior patterns and seeks to replace them.

The therapeutic relationship: an open and honest contact between therapist and patient

Therapist:
 often a psychiatric nurse
 has to be empathetic and non-judgmental

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U15 Outpatients
Outpatient: a patient who comes to hospital either to see a specialist for a diagnosis or for treatment and leaves
on the same day.

Inpatient: occupies a bed on a ward for treatment, tests or observation.

Outpatient care = ambulatory care (’ambulatory’ means ‘able to walk’)

- much cheaper than inpatient care
- see more patients than other hospital sectors
- usually done by appointments

Methods of organizing appointments are frequently updated and varies from hospital to hospital:

1 A patient is referred to outpatients by their doctor sending a letter of referral to the hospital. This is
done if the doctor considers it necessary for their patient to see a specialist consultant or to have
treatment or tests that only a hospital can provide.
2 The letter of referral is reviewed by the consultant, who decides which patient is urgent and which can
wait.
3 The hospital sends a letter to the patient with a date for a first appointment which the patient is then free
to cancel or rebook.
4 When patient attends first appointment:
o May be expected to bring:
 a specimen
 a list of medication they are taking
o The consultant:
 May discharge them back to their doctor
 Or arrange for follow-up appointments

Surveys and studies show:

 The percentage of appointments cancelled by:
 patients: 12%
 hospitals themselves: more or less 12%
 The percentage of non-attendance (patients who fail to keep their appointments and do not notify the
hospital): 10% - 20%
- Non-attendance is a major problem:
each non-attendance costs a hospital an average of: £100
no scheme to cut the amount of non-attendance ever seems to work
outpatients department compensate by overbooking appointments

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Common reasons for complaints by patients:

 the length of time people wait for an appointment

shortage of doctors
 the length of time people wait in hospital

Because of the impact on hospital outpatients departments & to make treatment faster and more efficient:

- many countries are expanding the roles of nurses

Nurses now have greater responsibilities:
 for administering drugs
 in hospital wards
 seeing many outpatients
 running follow-up clinics
 carrying out procedures: endoscopies

- e-patients; people who use the internet:

for information about their medical conditions
consult with doctors
consult with nurses who work online by giving advice and running forums

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