Wounds, Charts and Medication:

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Wounds, Charts and Medication

• Tips on teaching nurses
• Virginia Allum

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Introducing ..Virginia Allum

• Co-author with Patricia McGarr of Cambridge
  English for Nursing (Int Plus and Pre-Int)
• Currently Staff Nurse in a private hospital (mix
  of private and NHS patients)
• Productive Ward Project Leader and Infection
  Control Link Nurse

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Our session today

• Well look at Wounds (an example of a nursing
  procedure ) / youll do some medical terminology
  activities
• Well look at Charts (example of common writing
  skills needed by nurses) / youll complete a
  Wound Chart
• Well look at Medication (use of maths terms and
  abbreviations) / you do a Find-a-Word

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Before we start , Why teach Specialist English
for Nurses?

• Nurses leave NHS for better life abroad
• Daily Mail 7 Nov,2010
• An increasing number of overseas nurses are
  already arriving in Britain to fill the rising
  number of hospital vacancies.
• Last year Britain imported 8,500 nurses and
  midwives - many coming from poor countries such
  as India, Pakistan and the Philippines.

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What do stakeholders demand of overseas nurses?

• Ability to communicate effectively
• Safe practice
• High standards of technical knowledge
• Cultural sensitivity and awareness
• Good teamwork
• Ability to work with other Health Care
  Professionals

www.nursepostcard.com
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Here to Stay? International Nurses in the UK
2003 (NMC)

• Four main areas of concern for hospital managers
  who employ overseas nurses
• 1. language
• 2. differences in clinical and technical
  skills
• 3. racism in the workplace
• 4. reaction of patients.

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Language areas of need

• Everyday communication
• Nurse-to-nurse communication
• Technical knowledge (medical terminology)

http//www.nursingtimes.net/pictures/182xAny/7/2/1
/1205721_1205409_nurse_talking_paperwork.jpg
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Lets look at wounds...

• Or any nursing procedure
• Specialised language (look at wound websites,
  prefixes suffixes) (R, S, L, W)
• Recycle general English (asking for info, giving
  advice, assessing pain, giving directions)
• Maths terms e.g dimensions of wound, amount of
  discharge
• Opportunity for role plays

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A word about role plays

• They are serious enough for ESP
• Perfect opportunity to use specialised language
  in authentic situations (lots of handovers,
  telephone referrals in nursing)
• Ss can write them and own them
• Bring in guest speakers (e.g real nurses or
  student nurses ) to confirm authenticity

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Wounds opportunity to look at...

• Verbal descriptions e.g. in handover
• Written descriptions e.g. Wound Chart
• Abbreviations
• Equipment e.g Dressings
• Documentation Care pathways
• Staff in specialty areas Infection Control
  Nurse, Tissue Viability Nurse

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What is there to say about wounds?

• Types of wounds (surgical, ulcers, lacerations
• Position on body (on the right ankle)
• Description ( order of adjectives)
• Colour (of the surrounding skin, wound
  discharge)
• Size (width and depth)
• Amount of exudate (small, moderate, copious)

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What else?

• Presence of drains
• Equipment used (VAC)
• Dressings ,surgical tape, bandages
• Sutures, clips, staples and Steristrips
• Nursing jargon v medical term (healing v
  granulating )

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Types of wounds

• Vocab use Pharmaceutical company websites e.g.
  http//int.hansaplast.com/med-info/wound-care-bea
  utiful-healing/types-of-wounds.html
• Use pictures or diagrams match terms
• e.g. Match medical term to everyday term e.g
  contusion bruise
• Use nurse education on Pharmaceutical sites e.g.
  T.I.M.E on Smith Nephew

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Warning Pictures of wounds on next slide

• Use authentic photos of wounds if possible
• Be advised that some are pretty awful!
• Next slide not too bad but..

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2
4
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Now, in pairs, do handout exercise 1.
Photo number Type of wound
1 Pressure Ulcer
2 b)Surgical wound
3 c) Cut or laceration
4 d) Bruise or contusion
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Describing a pressure wound What can you get
out of it for a lesson?

• Use body diagram (front and back) see WSheet
• Practice of body parts (everyday v medical term)
• Practice of Where is the wound? (Position of
  the wound)- The wound is over the right lateral
  malleolus (ankle)
• Exercise Blank diagrams of the body with
  numbered wounds. In pairs, Where is wound (!)?

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Body Diagrams

• Terminology (body position anterior, posterior
  etc) on the back of..
• Parts of the body e.g where pressure ulcers may
  occur - on her sacrum
• Everyday terms versus medical terminology -
  shoulder blade scapula

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Now, in pairs, do Exercise 2

• Look at the numbered diagrams of the body
• Complete the table using terms in the box below
• Further activities make up double-side cards
  (everyday term one side, medical term reverse
  side) pr work.
• Speed work, 2 groups , complete table on WB .
  First team to get rid of cards, wins

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Humerus Outside ankle bone back of the
head calcaneus inside ankle
bone Thigh bone pinna shoulder
blade hip bone lower back
Olecranon process spine flank

Number Everyday term Medical terminology
1 Heel (Heels)
2 Lateral Malleolus (Malleoli)
3 Medial Malleolus (Malleoli)
4 Greater Trochanter (s)
5 Sacrum
6 Ischial Tuberosity (Tuberosities)
7 vertebrae
8 Occiput
9 Ears
10 Shoulders
11 Scapula (Scapulae)
12 Elbow (Elbows)
13 Iliac Crest
Humerus Outside ankle bone back of the
head calcaneus inside ankle
bone Thigh bone pinna shoulder
blade hip bone lower back
Olecranon process spine flank
Humerus Outside ankle bone back of the
head calcaneus inside ankle
bone Thigh bone pinna shoulder
blade hip bone lower back
Olecranon process spine flank
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Matching cards - example
Haemat- -oma erythr- Ven-
Necro- -itis Ser- Esch-
scab red blood Swelling
plasma dead Inflammation of Vein
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Using websites for inspiration

•                                                 
                                   

• http//news.bbc.co.uk/1/hi/health/1751163.stm

'Living bandages' for wounds The technology for
the 'bandage' was adapted from drinks cartons
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Online BBC Radio Transcripts

• http//www.bbc.co.uk/radio4/science/casenotes_tr_2
  0050208.shtml
• RADIO SCIENCE UNITCASE NOTES 9. - Wound
  Healing

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Use clips on websites Wounds UK
http//www.wounds-uk.com/

• Use demonstration videos as Listening Practice.
• Prepare worksheets (missing terms)
• Vocab matching
• Ss design a teaching session e.g. How to set up a
  negative pressure wound treatment / in prs teach
  each other

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Charts and Documents

• Legal documents
• Completed each shift
• Used as communication between shifts
• Nursing Care Plans
• Integrated Care Pathways (Wound Charts)
• Policies and Procedures

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What are Nursing Care Plans?http//www1.us.elsev
ierhealth.com/MERLIN/Gulanick/Constructor/index.cf
m?plan32

• Use the online resource to create a printable
  Care Plan
• Use as vocab resource
• Use as Handover Resource S (nurse) gives
  information about wound care during handover e.g
  Ive encouraged increase intake of protein-rich
  foods to help healing.

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Integrated Care Pathways Wound Chart

• ICPs require nurse to tick correct box
• Reading gt Writing
• Specific terms used
• Assessment often uses grading system (Grade 1
  not too bad ? Grade 5 very serious

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Wound Chart on p2 of worksheet

• Vocab work prefixes and suffixes - flashcards
• Description of wounds recycle descriptive
  language, order of adjs
• Grade of pressure ulcer match photos
• Wound drainage (discharge) jargon- purulent
  discharge pus, discharge ooze

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Example of wound chart
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Now, Exercise 3 Where is the wound?

• Complete the Wound Chart using information in the
  scenario

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WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924 WOUND CHART NAME Mrs A. Patient DOB 30/ 11/ 1924
WOUND TYPE TICK WOUND APPEARANCE Tick Wound Drainage Tick Pain Tick
Abrasion Blister Purulent (pus) Site
Haematoma Erythema (Redness) Haemoserous (Blood-stained fluid) Dressing change
Laceration Inflammation Nil continuous
Ulcer Maceration (over-moist) intermittent
Surgical incision Slough When limb elevated
Eschar (black, hard scab) Nil
Epithelialisation (healing tissue)
Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change. Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change.
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The Wound Chart ex can be ..

• A practice of handovers (write a dialogue using
  given info / complete missing terms in dialogue/
  practise as a role play )
• Used for different scenarios (dog bite, fall ,
  burn, operation)
• Used to recycle language ( Shes got a .. , The
  ulcers on her sacrum...)
• A practice of vocab of body parts / areas

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Scenarios..here is another

• Mr D Hatworth was repairing his fence when he
  accidentally dropped a piece of wood which grazed
  his right lower leg. He left the wound untreated
  for two weeks apart from dabbing on a bit of
  antiseptic cream. Now, the wound is painful to
  touch and is red and inflamed. There is a small
  amount of blood-stained discharge

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Answers students complete wound chart

• Wound abrasion
• Wound Appearance erythema, inflammation
• Wound Drainage Haemoserous
• Pain Site

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Also, wound charts are a chance to..

• Do vocab exercises e.g prefix and suffixes e.g
  necro-, -osis, haemat- , -oma, erythro- , ven-,
• Make matching cards / flashcards
• Practise communication skills e.g Advise patient
  on after care of wound dressing - Its important
  to keep the dressing dry, Youll have to come
  back next week for a new dressing ? make an
  appointment / make a phone call to confirm
  appointment with patient

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Wound Chart language

• Wound Type Its a ..
• Wound Appearance - Its got.. , Its got an
  area of..
• Wound Drainage Theres a small amount of..
• Pain - Is it painful? , Do you have any pain?
  When is the wound painful?

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Medications important area!

• Safe and accurate practice is essential
• Legal and patient health implications
• Oral medications (tablets, liquids)
• Nebulizers and inhalers
• Injections IMI ,IVI,
• IV fluids
• PR medications (suppositories, enemas)
• Oxygen

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Language skills needed

• Abbreviations (R, W, L and S) e.g bd, tds
• Maths terms e.g. Morphine 15mg pronun. practice
• Measurement terms e.g ml, mcg, 80, mg/ml, units
• Medication use e.g Read entries in BNF or MIMS
  e.g side effects
• Check for interactions with other drugs e.g (R)
  literature on drug in blurb or on internet
• Handover information e.g (S) intolerance to pain
  killer

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Medications opportunities for?

• Research practice journals, EBP online
• Writing practice e.g develop a Public Health
  Poster on Hypertension drugs ? present to class
  (speaking practice)
• Reading and comprehension practice e.g. Compare
  drugs used for diabetes- small group work,
  present to class ? teamwork

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Medication language practice

• Abbreviations e.g sc, prn
• Terms e.g nocte, mane
• Instructions e.g. Take this medication after food
• Polite advice e.g It would be a good idea to..
• Warnings e.g you must keep the medication in the
  fridge

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The Medication Chart

• Understand terms used in the chart
• Get a copy of a medication chart for practice
• Latin terms
• Maths terms
• Use flashcards, cross-words, Find-a-Word to
  practise terms

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Drug Chart - example
Allergies Adverse Drug Reactions
BD QDS TDS
Anti-coagulants
Slow Release
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Ex 4 Medication Table

• Read through the terms in the medication table
• Ask your teacher if you dont understand any
  terms
• Now, take turns to find a term explain the
  meaning to your partner
• Hint break into chunks or students will not
  survive this exercise!

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Medical terms for medications Meaning
a.c Before meals
amps. Ampoules . This is the container for liquid medication for injection.
b.d (or b.i.d) Twice a day (bi two)
Inh. Inhaler e.g Salbutamol inhaler
IM or IMI Intramuscular ie an injection given into a muscle
IV or IVI Intravenous ie an injection given into a vein
IV Fluids Fluids given through an IV cannula. Also called a drip
mane In the morning
Neb. Nebulizer e.g Salbutamol nebulizer
Needle gauge Size of the needles eg 19g (drawing up needle) 21g (IM injections ) 23g (fine for sc injections)
NI Nurse Initiated medication e.g. Paracetamol, Coloxyl with Senna.
nocte At night
OD or daily Once a day
oral By mouth
p.c After meals
per NG through the nasogastric tube (through nose into the stomach)
pr Per rectum e.g. a suppository
prn whenever needed ( for pain, indigestion, constipation)
q.i.d or qds Four times a day (quad 4) .Doesnt have to be in 6 hour intervals.
R Refused by the pt. (written on the medication chart)
s.c Subcutaneous ie an injection given into the subcutaneous layer of skin
s.l Sublingual or under the tongue
stat (statim) immediately e.g. a stat dose of insulin
t.d.s Three times a day (Ter in diem)
top. Topical ie a cream or ointment e.g antibiotic cream
units Insulin is prescribed in units. E.g. 24 units of Insulotard
Venflon Type of intravenous cannula. Abbrev to IVC .
W Withheld (written on the medication chart) e.g. Digoxin because the pulse was 58.
1/24 or 10 Hourly or every hour
2/24 or 20 Second hourly or every two hours
4/24 or 40 Fourth hourly e.g. 4/24 T P R (Note this is 6 times a day)
6/24 or 60 Every six hours (Note this is 4 times a day)
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Medication Find-a-word

• In pairs, find a word relating to medication
  administration in the Find-a-Word
• Tell your partner what it means
• Use previous glossary to help you

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In pairs, identify a term in the Find-a-Word
below using the table above. Explain the meaning
of the term to your partner.
A N E B
M O O S
P E R R E C T U M
O A T B A
U L O E L N
F L U I D S I E
E N N C I N H
I J G
T E U
S C Q D S A
T R L A
A N T I B I O T I C
O P
V E N F L O N
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Good medication calculation sites for nurses
lots of related terms

• Medication Terms
• http//home.sc.rr.com/nurdosagecal/Conversions.htm
  
• http//www.jcu.edu.au/cgi-bin/nursing/test.cgi
  (if you have problems go to www.jcu.edu.au and
  Search Nursing Calculations Practice

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Other medication activities

• Reading a Medication chart use scenario
• The IV Prescription Chart
• The 5 Rights of Drug Administration research
  and make an educational poster
• Practice of role plays for medication
  administration / recycle questions / asking for
  information Do you need something for pain? /
  giving advice Its best to take this tablet
  with food

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Tips Use websites

• http//www.bhf.org.uk/living_with_a_heart_conditio
  n/treatment/medicines_for_the_heart.aspx
• http//www.proprofs.com/flashcards/story.php?title
  types-wounds

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Invite guest speakers

• Nursing lecturers
• Nursing students
• Nurses
• Ask them to show authentic charts and
  documentation (make sure any identifying
  information is obscured first) e.g hospital logo

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Any questions?

• Thank you for having me
• PS answers to the exercises are on my blog
• http//englishfornursingandhealth.blogspot.com/