UNIT 2 Educating patients about asthma management In pairs, look at the picture and discuss the following questions. What do you think this equipment is used for? 2 Have you used this equipment before? ^2.1 Eleanor is an Asthma Clinic Nurse. One of her roles is to educate patients in their asthma management. Listen to a conversation with a patient, Mrs Drake, and answer the following questions. 1 How does Mrs Drake feel? 2 Why is Eleanor teaching her to use a peak flow meter? 3 At what time of day should she take the reading? 4 What three things does she have to remember? ► 2.1 Listen again and complete the following extracts. 1 ... a peak flow meter today._if I go through it with you now? 2 Now,_to use this peak flow meter at the same time every day. 3 Another thing -_ record your readings in this Daily Record Chart, please? Unit 2 Respiratory problems d You are going to listen to Eleanor giving instructions on using the peak flow meter. Before you listen, put the following sentences in the correct order. □ The last thing to remember is to record the highest of the three readings on your Daily Record Chart. □ After that, I want you to blow into the peak flow meter two more times. □ Next, blow as hard and as fast as you can with one breath. LD Right, first of all, just move the red indicator to the bottom of the numbered scale, like this. □ Now, stand up. Take a deep breath and try to fill your lungs as much as you can. □ Make a note of the final position of the marker, e ^2.2 Listen and check your answers. f Find the instructional language in the audioscript on page 95. What do you notice about the verb forms? Communication focus: giving instructions effectively 2 3 In pairs, discuss the following questions. • Do you know any techniques for giving instructions effectively? • How can you make sure your instructions are effective? b Complete the strategies for giving instructions effectively (1-8) using the words and phrases in the box. at the same level demonstrate I'm going to teach you how to ... understood repeat smiling firstly, secondly That's right fingers 1 Put the listener at ease by using positive non-verbal communication such as _swlUng_ 2 Sit or stand_as the patient. 3 Give encouragement by making remarks such as_, Yes, good, Well done, etc. 4 State the purpose of the communication before giving instructions, to prepare the listener for important information; for example: 5 Use a level of language which can be_by the listener. 6 Give instructions in steps, for example _, etc. You could count the steps on your_to make sure your patient understands you. 7 _instructions on the relevant piece of equipment. 8 _instructions and allow the listener to ask questions. C ► 2.1 & 2.2 Which of the strategies does Eleanor use with Mrs Drake? Listen again and find examples in the audioscript on page 95. d In pairs, practise giving instructions on how to use the peak flow meter. Student A, you are Eleanor; Student B, you are Mrs Drake. Remember to include strategies for giving instructions effectively. Swap roles and practise again. Unit 2 Respiratory problems 15 Using a nebuliser 3 a In pairs, discuss the following questions. 1 What is your experience of asthma management? 2 What kind of asthma treatment is available? b ^2.3 Some asthma medication is delivered to the patient using specialised equipment. Mr Dwyer's treatment plan for his asthma management is being changed. Listen to the Ward Nurse, Melanie, instructing Mr Dwyer on how to use a nebuliser for the first time and put the following steps in the correct order. D Breathe in the mist □ Turn on the oxygen □ Put on the mask D Put in the medication □ Connect to the oxygen C Match the beginnings (1 -5) to the endings (a-e) to complete Melanie's instructions. a put on the mask and tighten the elastic straps so that it fits snugly around the head, b inhale the mist until it's finished, c fill the chamber of the nebuliser... d turn on the oxygen so the liquid medication turns into a fine mist, e attach the tubing to the oxygen outlet on the waLl. d ^2.3 How does Melanie give instructions effectively? Listen again and find examples in the audioscript on page 95. 6 In pairs, practise giving instructions on how to use a nebuliser. Student A, you are Melanie; Student B, you are Mr Dwyer. Remember to include strategies for giving instructions effectively. Swap roles and practise again. 1 First of all, 2 Now, 3 Next, 4 After that, 5 Finally, Share your knowledge In small groups, discuss the following questions and then feed back your group's ideas to the class. • What techniques do you find most useful when giving instructions? • What techniques are not helpful when giving instructions? • Have you ever encountered problems when giving instructions to a patient? 16 Unit 2 Respiratory problems Medical focus: the respiratory system Talking to a child about asthma Tin. a Charge Nurse on the Paediatric Respiratory Ward, is describing the mormal flow of air into the lungs to Susie, an 8-year-old patient. She has been admitted after having her first serious asthma attach and needs education about managing her condition. 4 a ►m Listen to the conversation and label the parts of the respiratory system using the words in the box. -in: cavity alveoli threat or phatynx windpipe or trachea oral cavity voice box or larynx pleural membrane epiglottis intercostal space bronchus Healthy airways Asthmatic airways In pairs, look at the pictures of a healthy airway and an asthmatic airway and discuss the following questions. 1 What differences do you notice between the two airways? 2 How can you tell if someone is having an asthma attack? ►2.5 Listen to the rest of Tim and Susie's conversation and write healthy (H) and asthmatic (A) for the following sentences. 1 a A lining of healthy tissue which is not swollen. b A thickened lining of tissue which is often inflamed. 2 a The contracting muscle layer makes breathing more difficult. b The contracting muscle layer helps conduct air into and out of the alveoli. 3 a Gas exchange occurs in the tiny air sacs called alveoli. b The exchange of carbon dioxide and oxygen is hindered by narrowed airways. 4 a Wheezing sounds indicate respiratory effort, b Respiration is quiet and easy. Unit 2 Respiratory problems 17 d ►is Listen again and complete the following flowchart. What do you notice about the verb forms in 1 -4? Healthy airways Asthmatic airways Tissue is not thick Tissue (1)_ I \ Muscle layer contracts Airway (4)_ \ \ >) Air (2)_into and out Chest muscles (5) of the alveoli C02 (3)_with 02 Difficult (6) Communication focus: putting a young patient at ease 5 a In pairs, discuss the following questions. • What strategies can you use to put a young patient at ease? • Have you used any of these strategies yourself? Were they successful? b Complete the strategies for putting a young patient at ease (1-8) using the words in the box. simple small talk encouragement diagrams explain # cheerful appeal level decision-making 1 Use swoOl Knlk ( for example asking about the child's hobbies or interests. 2 Stand or sit at the same_as the child. 3 Use_, clear sentences and check for understanding. 4 Use pictures or_to illustrate what you are saying. 5 Involve the child in_, for example: Let's call this one healthy airways - does that sound like a good idea? 6 Give__ 7 Use short, simple phrases which_to children, for example: the little flap. 8 Use a_tone of voice. 9 _medical terminology in simple terms. C ► 2.4 & 2.5 Which of the strategies does Tim use with Susie? Listen to the whole conversation again and find examples in the audioscript on page 95. d In pairs, practise the dialogue. Swap roles and practise again. e Natalie, a 10-year-old asthmatic, has been admitted after a severe asthma attack. This is the first asthma attack she has suffered. Candy, the Nurse Educator in the Respiratory Unit, needs to explain what happens to the airways when Natalie has an asthma attack. In pairs, use the diagram of healthy airways and asthmatic airways on page 17 to explain what happens in an asthma attack. Student A, you are Candy; Student B, you are Natalie. Remember to use strategies for putting a young patient at ease. Swap roles and practise again. 18 Unit 2 Respiratory problems Describing respiration Match the medical terms (1-7) to their meanings (a-g). 1 inspiration--— a at four litres per minute E inspiratory rate b the rate at which a person breathes out (expressed as breaths per minute) 3 respirations c breaths - that is, movement of air in and out of the lungs 4 respiratory rate d the rate at which a person breathes in (expressed as breaths per minute) 5 expiration e breathing in 6 expiratory rate f the rate at which a person breathes in and out (expressed as breaths per minute) 7 @ 4L/min g breathing out b Underline the stressed syllable in words 1 -6. C In pairs, take turns to say a word and ask your partner to define it, or give a definition and ask for the word. d ^2fi Listen to four extracts from conversations on a ward and answer the following questions. Pay attention to the pronounciation of the words in Exercise 6a. 1 Why are Mr Frank's family going to stay with him tonight? 2 How is Judy managing her pain? 3 How was oxygen administered to Mr Walker? 4 What caused Mr Sims' tachypnoea? e In pairs, look at Mrs Oondahi's Nursing Notes and ask and answer questions using the prompt cards. Student A, turn to page 86; Student B, turn to page 93. DATE & TIME Add signature, printed name, staff category, date and time to all entries MAKE ALL NOTES CONCISE AND RELEVANT Leave no gaps between entries 2.3.0? ZLOOhrs NURSING AVs Oondahi appears to be breathing comfortably at the time of the report and is quite settled. RR is IG, not laboured. 0, @ 3L/min via nasal cannulae. Pt lying on two pillows. 'Pain relieved by morphine via continuous s.c infusion. Vain rated at 1/10 at 2030hrs. Patient states she is comfortable. Family in attendance all shift. Husband and children will stay overnight with her. V>. (RN) SIMPSON hare your knowledge In small groups, discuss the following questions and then feed back your group's ideas to the class. • Are family members / partners permitted to stay with a dying patient in hospital in your country? • What are the benefits of allowing this arrangement? • Are there any difficulties with this arrangement? Why is it important to be culturally sensitive in this type of situation? * Unit 2 Respiratory problems 19 Charting and documentation: respiratory rates Mr Wilmott, an 86-year-old who lives alone, has been admitted to hospital for treatment. In pairs, look at his record and discuss the following questions. 1 What is Mr Wilmott's diagnosis? 2 What is the treatment? 3 What is happening in the morning? A What respiratory assessment has he started doing himself? THE ALEXANDRA HOSPITAL PATIENT RECORD U/N: 593712 Surname: Wilmott Given names: Ronald DOB: 15.9.1922 Sex: Male DATE & TIME Add signature, printed name, staff category, date and time to all entries MAKE ALL NOTES CONCISE AND RELEVANT Leave no gaps between entries 7 7:00 ZW3/0& New admission to the ward with a diagnosis of poorly managed asthma. 'Recent (JRTI treated with antibiotics. Vt still c/o 503. TZR elevated. For CX~R and review by respiratory Team in am. Started on piY readings and Vt ed. regarding asthma. c. TxUaneu* CRN) VtZLANE-Y b Match the abbreviations from the Patient Record (1-6) to their meanings (a-f). 1 URTI - 2 SOB 3 RR 4 CXR 5 p/f 6 Pted. a respiratory rate b peak flow; the most air which is expired c chest X-ray d patient education ■ e upper respiratory tract infection f shortness of breath; difficulty breathing (dyspnoea) C In pairs, take turns to ask for the meaning of an abbreviation. d ^2.7 Mrs Castle is a 56-year-old with a past history of respiratory problems relating to chronic asthma. Listen to a conversation between two Ward Nurses, Mandy and Rosa, and answer the following questions. 1 How often is Mrs Castle having her respiratory rate checked? 2 How much oxygen was she having when she returned from her operation? 3 Why was she given oxygen? 4 How long will Mandy be away? e ^2.7 Some of the information on Mrs Castle's Obs. Chart on page 87 is incorrect. Listen again and correct any mistakes. Unit 2 Respiratory problems Match the medical terms (1-5) to their meanings (a-e). 1 apnoea '. : :.. pnoea 3 eupnoea 4 tachypnoea 5 dyspnoea a the patient has Laboured breathing or difficulty breathing b the patient is not breathing at all c the respiratory rate is rapid; it has increased to between 20 and 30 breaths per minute d the patient's breathing is slow rate; the respiratory rate is Less than 12 breaths per minute e the patient is breathing a normal respiratory rate - between 12 and 20 breaths per minute Underline the stressed syllable in words 1-5. In pairs, answer the following questions. 1 The word element -pnoea (US -pneo) means breathing. Is the p a silent letter in all words which are formed using this word element? 2 If not, which word(s) in Exercise 6f do not have a silent p? Read the entry in Mrs Castle's Patient Record made by Dr Smith, the Senior House Officer, and answer the following questions. 1 What do the abbreviations AE and FBC stand for? 2 Does Mrs Castle have a high temperature? 3 Are her respirations fast or slow? 4 When will she have the blood test done? 5 Was she taking aspirin before? THE ALEXANDRA HOSPITAL V" PATIENT RECORD U/N: 593712 Surname: Castle Given names: Rebecca DOB: 15.9.1922 Sex: Female DATE & TIME Add signature, printed name, staff category, date and time to all entries MAKE ALL NOTES CONCISE AND RELEVANT Leave no gaps between entries W02/09 Surgical SHO Smith Ft is conscious tachypnoeic 36 KK afebrile lung auscultation \ AE bilat. basely no crackles or wheezes Plan CKF in am F3C today please aspirin to be restarted next week F.H. Smith SMITH (bleeper: 8516) in pairs, take turns to ask and answer more questions about Mrs Castle's Patient Record. Student A, you are handing over Mrs Castle to Student B. Swap roles and practise again. Unit 2 Respiratory probt