Lesson 1

The Human body

One of the first things you need to know when working in English is the parts of the body. You
will need to learn the names of the internal (inside the skin) and external body parts. You will
also need to learn the words for the functions of each of these body parts. Here are the basics to
get you started.

Head

Inside the head is the brain, which is responsible for thinking. The top of a person's
scalp is covered with hair. Beneath the hairline at the front of the face is the forehead.
Underneath the forehead are the eyes for seeing, the nose for smelling, and the mouth
for eating. On the outside of the mouth are the lips, and on the inside of the mouth are
the teeth for biting and the tongue for tasting. Food is swallowed down the throat. At the sides of
the face are the cheeks and at the sides of the head are the ears for hearing. At the bottom of a
person's face is the chin. The jaw is located on the inside of the cheeks and chin. The neck is what
attaches the head to the upper body.

Upper Body

At the top and front of the upper body, just below the neck is the collar bone. On
the front side of the upper body is the chest, which in women includes the
breasts. Babies suck on the nipples of their mother's breasts. Beneath the ribcage
are the stomach and the waist. The navel, more commonly referred to as the
belly button, is located here as well. On the inside of the upper body are the
heart for pumping blood and the lungs for breathing. The rear side of the upper body is called the
back, inside which the spine connects the upper body to the lower body.

Upper Limbs (arms)

The arms are attached to the shoulders. Beneath this area is called the armpit or
underarm. The upper arms have the muscles known as triceps and biceps. The joint
halfway down the arm is called the elbow. Between the elbow and the next joint,
the wrist, is the forearm. Below the wrist is the hand with four fingers and one thumb. Beside the
thumb is the index finger. Beside the index finger is the middle finger, followed by the ring
finger and the little finger. At the ends of the fingers are fingernails.

Lower Body

Below the waist, on left and right, are the hips. Between the hips are the reproductive
organs, the penis (male) or the vagina (female). At the back of the lower body are the
buttocks for sitting on. They are also commonly referred to as the rear end or the
bum (especially with children). The internal organs in the lower body include the intestines for
digesting food, the bladder for holding liquid waste, as well as the liver and the kidneys. This
area also contains the woman's uterus, which holds a baby when a woman is pregnant.

Lower Limbs (legs)

1
The top of the leg is called the thigh, and the joint in the middle of the leg is the knee. The front
of the lower leg is the shin and the back of the lower leg is the calf. The ankle connects the foot
to the leg. Each foot has five toes. The smallest toe is often called the little toe while the large one
is called the big toe. At the ends of the toes are toenails.

2
 A. Complete the dialogue by putting the correct word or words into the space.

X : Do you have a problem with your part of your body?

Y : No, I don’t have a problem with my part of my body
Yes, I have a problem with your part of your body

X : Do you know all part of your body?

Y : No, I____________
X : Do you know the upper part of your body?
Y : Yes, I________________
X : Do you _________ (remember/remembers) the lower limb part of your body in English?
Y : No, I remember the lower part of your body in English
X : _____ you understand the upper limb part of your body in English?
Y : Yes, I understand the upper limb part of your body in English?

B. Practice the dialog with your partner

C. Now ask your partner the question. Your partner must give answers which are true for
him or her. Write their answers.

Friend’s Name
Questions
1. 2. 3.

All part of your body

Upper part of your body

Lower limb part of your body

Upper limb part of your body

D. Feel the blank sentence below with the correct word

1. If your …. hurt, you should go to the dentist
2. If you open your …. you will see better
3. A wedding ring is worn on the ….

3
 4. Pinocchio got a very big …. because he told too many lies
5. If you are very cold, put a woolen scarf around your....
6. Eating is very easy. You just put food into your ….
7. If you drink too much beer, your …. will hurt the next day
8. Be careful not to injure your …. when you lift something heavy
9. Men who drink a lot of beer often have large ….
10. You put socks on your ….

E. Human body quiz. Circle the correct answer

1. your tonsils can get swollen when you have (thigh/toe/throat/lips)

2. The (elbow/ankle/shoulder/knee) is located in the middle of the arm
3. My Dad's little (thumb/toe/wrist/armpit) was lost in the accident
4. The patient lost so much weight his (calves/thigh/muscles/cheeks) were sunken in
5. We will put a cool cloth on you (knees/tongue/teeth/forehead) to get your fever down
6. Another word for belly button is (knee/navel/chest/stomach)
7. The newborn is getting his (thigh/bum/shin/heart) changed in the nursery
8. She may never walk again because her (uterus/spine/finger/eye) was so badly injured
9. The (collar bone/limb/teeth/skin) on his knee was scraped off when he hit the road
10. Your grandfather will be able to walk better after his (chain/waist/hip/arm) surgery

F. The Function Part of Body

Extract from Anatomy course lecture

Welcome to today's lecture. Last week we looked at the respiratory system and how

the lungs separate oxygen from other gasses which we breathe. Today, we will be looking at co-
dependence within three of the body's most important systems: the central nervous system (CNS),
the cardiovascular system and the digestive system.

The nervous system can be divided into two parts: the central nervous system and the peripheral
nervous system. The central nervous system is comprised of the brain and the spinal cord, and is
responsible for processing the information which is sent to or received from the peripheral
nervous system which is made up of the body's nerves. The brain processes information while the
spinal cord acts as a delivery system for the information and impulses.

Information transmitted through the central nervous system tells our bodies how to react in a
certain situation, such as when we want to take a step the brain tells our knee joint to bend, or
when we touch something hot we receive information giving us a burning sensation. The CNS
also sends information about infection so that the appropriate organ e.g. the spleen can fight
certain types of bacteria. It is a common misconception that the brain is the largest organ in the
human body, when in fact it comes in at third largest after the skin and the liver respectively.

4
The central nervous system also controls our second system of the day, the cardiovascular system
(also known as the circulatory system) which delivers blood and oxygen to the various parts of
the body. The relationship between these two systems is quite complicated as each has an effect
on the other. If we take the heart for example which is a key organ in the cardiovascular system,
we can think that it feeds the brain and as such the CNS with oxygen and blood, but at the same
time it is the brain that controls the heart telling it how often to beat.

In fact the cardiovascular system is not only responsible for delivering blood and oxygen, but
also for transporting nutrients, hormones and waste throughout the body. All of these are carried
in the blood, of which an average adult has about 5 liters. The heart acts as a pump which
circulates the blood through the capillaries, arteries and veins. It is interesting to note that if these
were laid end-to-end, the estimated length would be 100,000 KM.

Our next system, the digestive system is closely linked to the cardiovascular system as on the one
hand it requires about 30% of all cardiac output. And on the other, the digestive system separates
nutrients from food before they can be distributed via the cardiovascular system. Thus, as with
the relationship between the CNS and the cardiovascular system, each system needs the other to
work.

When thinking about the digestive system, the first organ that comes to mind is usually the
stomach but surprisingly, this is not the largest organ in this system. That is, in fact the liver
which is actually the largest solid organ in the body. The liver performs several functions among
which are cleaning the blood, producing digestive liquids (bile) and storing energy. Again, we
can see examples of cross system relationships here.

As well as the liver and stomach, the digestive system is made up of the pancreas and
the intestine. The pancreas, like the liver, aids in digestion of food. After food has passed through
the stomach and has been 'ground' into tiny pieces, it enters the intestine where the bile is added
and the nutrients are extracted from the food. Waste products then move further down the
intestine. Now, don't forget to join me next week when we will examine the tonsils and
other glands.

Questions

1. 'heart'
a. the organ that controls the flow of blood in the body
b. the part of the nervous system comprising of the brain and the spinal cord
c. the system of organs and tissues involved in circulating blood and lymph through the body

2.'intestine'
a. a blood vessel that carries depleted blood back to the heart
b. the portion of the alimentary canal extending from the stomach to the anus
c. the organ that controls the flow of blood in the bod
3.'bile'
a. a bitter fluid that helps with digestion
b. the thick column of nerve tissue that extends from the base of the brain about two thirds of the
way down the backbone
c. a pair of organs in which oxygen from the air that is inhaled is transferred into the blood
4.'digestive system'
a. either of a pair of oval masses of lymphoid tissue, one on each side of the throat at the back of
the mouth
b. either of a pair of oval masses of lymphoid tissue, one on each side of the throat at the back of
the mouth

5
c. the part of the body that stores and processes food

5. 'spleen'

a. an organ in the body that secretes bile to help digest carbohydrates, fats and proteins.
b. an organ near the stomach that has various roles in purifying and storing the blood
c. the part of the nervous system comprising of the brain and the spinal cord

6. 'tonsil'
a. the part of the body that stores and processes food
b. either of a pair of oval masses of lymphoid tissue, one on each side of the throat at the back of
the mouth
c. the set of organs that allows a person to breathe and exchange oxygen and carbon dioxide
throughout the body

7. spinal cord'
a. the thick column of nerve tissue that extends from the base of the brain about two thirds of the
way down the backbone
b. an organ or group of cells that releases substances or waste from the body
c. the mass of nerve tissue located in the head of animals with spinal cords; it is the center of
thought and controls movement

8. 'joint'
a. a blood vessel that carries depleted blood back to the heart
b. a pair of organs in which oxygen from the air that is inhaled is transferred into the blood
c. a movable or fixed place or part where two bones or elements of a skeleton join

9. 'lungs'
a. a pair of organs in which oxygen from the air that is inhaled is transferred into the blood
b. this organ both regulates insulin and secretes enzymes to break down carbohydrates, proteins,
and lipids
c. a bitter fluid that helps with digestion

10.'respiratory system'
a. an organ in the body that secretes bile to help digest carbohydrates, fats and proteins.
b. the set of organs that allows a person to breathe and exchange oxygen and carbon dioxide
throughout the body
c. an organ or group of cells that releases substances or waste from the body

11. CNS' or 'central nervous system'

a. the part of the nervous system comprising of the brain and the spinal cord
b. a pair of organs in which oxygen from the air that is inhaled is transferred into the blood
c. the mass of nerve tissue located in the head of animals with spinal cords; it is the center of
thought and controls movement

12. brain'
a. the portion of the alimentary canal extending from the stomach to the anus
b. fiber forming part of a system that conveys impulses of sensation, motion, between the brain or
spinal cord and other parts of the body
c. the mass of nerve tissue located in the head of animals with spinal cords; it is the center of
thought and controls movement

13. vein'
a. a bitter fluid that helps with digestion
b. the part of the nervous system comprising of the brain and the spinal cord
c. a blood vessel that carries depleted blood back to the heart

14. gland'

6
a. the part of the body that stores and processes food
b. the system of organs and tissues involved in circulating blood and lymph through the body
c. an organ or group of cells that releases substances or waste from the body

15. 'cardiovascular system'

a. a blood vessel that carries blood away from the heart
b. either of a pair of oval masses of lymphoid tissue, one on each side of the throat at the back of
the mouth
c. the system of organs and tissues involved in circulating blood and lymph through the body

16. nerve'
a. fiber forming part of a system that conveys impulses of sensation, motion, between the brain or
spinal cord and other parts of the body
b. the set of organs that allows a person to breathe and exchange oxygen and carbon dioxide
throughout the body
c. an organ or group of cells that releases substances or waste from the body
17. 'liver'
a. an organ or group of cells that releases substances or waste from the body
b. this organ both regulates insulin and secretes enzymes to break down carbohydrates, proteins,
and lipids
c. an organ in the body that secretes bile to help digest carbohydrates, fats and proteins

18. artery'
a. a blood vessel that carries blood away from the heart
b. this organ both regulates insulin and secretes enzymes to break down carbohydrates, proteins,
and lipids
c. a bitter fluid that helps with digestion

Lesson 2

7
 Simple Past Tense

I sang

The simple past tense is sometimes called the preterit tense. We can use several
tenses to talk about the past, but the simple past tense is the one we use most often.
In this lesson we look at the structure and use of the simple past tense, followed
by a quiz to check your understanding:

How do we make the Simple Past Tense?

Here you can see examples of the past form and base form for irregular verbs and regular
verbs:

V1 V2 V3
base past past participle

work worked worked

regular The past form for all
explode exploded exploded
verb regular verbs ends in -ed.
like liked liked

The past form for

irregular go went gone irregular verbs is
verb see saw seen variable. You need to
sing sang sung learn it by heart.

You do not need the past participle

form to make the simple past tense. It
is shown here for completeness only.

The structure for positive sentences in the simple past tense is:

subject + main verb

past
The structure for negative sentences in the simple past tense is:

subject + auxiliary verb + not + main verb

did base
The structure for question sentences in the simple past tense is:

auxiliary verb + subject + main verb

did base

The auxiliary verb did is not conjugated. It is the same for all persons (I did, you
did, he did etc). And the base form and past form do not change. Look at these
examples with the main verbs go and work:

subject auxiliary verb main verb

8
 I went to school.
+
You worked very hard.

She did not go with me.

-
We did not work yesterday.

Did you go to London?

?
Did they work at home?

Exception! The verb to be is different. We conjugate the verb to be (I was, you

were, he/she/it was, we were, they were); and we do not use an auxiliary for
negative and question sentences. To make a question, we exchange the subject and
verb. Look at these examples:

subject main verb

I, he/she/it was here.

+
You, we, they were in London.

I, he/she/it was not there.

-
You, we, they were not happy.

Was I, he/she/it right?

?
Were you, we, they late?

How do we use the Simple Past Tense?

We use the simple past tense to talk about an action or a situation—an event—in
the past. The event can be short or long.

Here are some short events with the simple past tense:

The car exploded at 9.30am yesterday.

She went to the door.
We did not hear the telephone.
Did you see that car?

past present future

The action is in the past.

Here are some long events with the simple past tense:

9
 I lived in Bangkok for 10 years.
The Jurassic period lasted about 62 million years.
We did not sing at the concert. Did you watch
TV last night?

past present future

The action is in the past.

Notice that it does not matter how long ago the event is: it can be a few minutes or
seconds in the past, or millions of years in the past. Also it does not matter how long
the event is. It can be a few milliseconds (car explosion) or millions of years (Jurassic
period). We use the simple past tense when:

 the event is in the past

 the event is completely finished
 we say (or understand) the time and/or place of the event

In general, if we say the time or place of the

event, we must use the simple past tense; we
cannot use the present perfect.

Here are some more examples:

 I lived in that house when I was young.
 He didn't like the movie.
 What did you eat for dinner?
 John drove to London on Monday.
 Mary did not go to work yesterday.

 Did you play tennis last week?

 I was at work yesterday.
 We were not late (for the train).
 Were you angry?

Note that when we tell a story, we usually use the simple past tense. We may use
the past continuous tense to "set the scene", but we almost always use the simple
past tense for the action. Look at this example of the beginning of a story:
"The wind was howling around the hotel and the rain was pouring down. It was cold.
The door opened and James Bond entered. He took off his coat, which was very
wet, and ordered a drink at the bar. He sat down in the corner of the lounge and
quietly drank his..."

This page shows the use of the simple past tense

to talk about past events. But note that there are
some other uses for the simple past tense, for
example in conditional or if sentences.

10
A. Exercise

1 The patient is arriving / arrives / arrived at 9.45 p.m. last night.

2 We didn’t called / didn’t call / calling an ambulance, because it wasn’t necessary.

3 Did you catch / catched / caught your cold at school?

4 I walked / am walking / was walking when the dog attacked me.

5 A Did she interview the patient? B Yes, she did / interviewed / do.

6 What were you doing while / when / during you broke your leg?

7 She didn’t / wasn’t / were concentrating while she was driving. 8 They were / was / been in a
fight.

B. Writing
Write your profile Read the example personal profile and write a similar one about
yourself,

explaining: • why you became a nurse

Example Personal Profile

When I was a child I wanted to be an accountant because mathematics was my favorite subject at
school. I was no good at science and not very good with people, so I thought that nursing was not
for me. But when I was sixteen my grandmother got very ill. I watched the nurses care for her as
she slowly died, and I realized that I wanted to be like them.

When I left school I applied to train as a nurse. A training college accepted me and I started the
course two years ago. I am still training and getting experience. I know that nursing is not right
for everyone, but personally I love it.

Lesson 3

In and Around The Hospital

11
Listen carefully, and then fill the blank sentence in the paragraph
Some hospitals specialize in particular conditions like 1_____ or psychiatric illness. Other
hospitals specialize in particular 2______ of patients like geriatrics, children or the terminally ill.
However, the best known type of hospital is the general hospital which 3_____ with almost
everything, has ambulance crews and beds for both intensive care and long stay.

A big general hospital has many different specialist departments. Identifying departments can be
4______ because different hospitals use different names for the same thing. For example, one
hospital may have a ‘children’s unit’ which a different hospital calls ‘Pediatrics’. ‘5______ and
Emergency’ (A&E) in one hospital is called ‘Casualty’ in another.

There are many other examples. The department that specializes in 6_____ problems, is
sometimes called ‘Coronary Care’. Others call it ‘Cardiology’ or ‘Cardiovascular 7_______’.
Nephrology, the department that treats illnesses of the 8_______ is sometimes called ‘the Renal
Unit’. Gastroenterology (digestive system) is sometimes ‘the Department of Hepatology’.

Hospital staff often use abbreviations for departments. For example, they refer to ‘Obs and
Gynae’. This is a department 9_______ Obstetrics (pregnancy), and Gynaecology (women’s
reproductive organs). They call Otolaryngology, ‘ENT’ (ears, nose & throat), mostly because it
is much easier to say.

A. Comprehension

a What three types of hospitals are mentioned in the text?

_________________________________________________________________________

b Which is the most common type of hospital?

_________________________________________________________________________

c Why are hospital department names confusing?

_________________________________________________________________________

d Which two departments mentioned in the text, deal with the gastrointestinal tract?

_________________________________________________________________________

e How many departments is ‘Obs & Gynae’?

_________________________________________________________________________

f What is a common name for the Otolaryngology Department?

_________________________________________________________________________

B. Vocabulary
Find terms in the text that means the same as a-g. The first one is done for you.

a mental health problems psychiatric illness____

b elderly people ___________

c people who are dying _________

d paramedics _________

e treatment for critically ill patients __________

12
f stomach and intestines _________

g uterus, ovaries and fallopian tubes ________

C. Further vocabulary practice

Match department names 1-6 with parts of the body a-f.

Department name Parts of the body

1 Coronary Care a tonsils

2 Gynaecology b cervix

3 Obstetrics c bowel

4 Gastroenterology d heart

5 ENT e kidneys

6 Nephrology f placenta

D. Key words from the unit

Complete the sentences with the words from the list.

1 ________are on the bottom grade.

2 ________often work in administration. qualified

nursing officers
3 The new job is a ________ for her.
promotion
4 Psychiatric nurses _________ in mental health. part-time apply
for a job
5 You can do a ________ course while you work. auxiliary nurses
rewarding
6 You need to send a CV when you ________ .
specialize
7 Contact with patients can be very _____________

8 We are looking for well _________ staff.

Lesson 4
Operating Room

13
Surgery is a branch of medicine concerned with treating diseases and injuries by means of
operative intervention, which means a surgeon operates on a patient in order to treat an injury,
improve the functions of the body or the patient's appearance.

The word 'surgery' originally comes from Greek, in which language it means 'hand work'. This is
actually a very adequate name, as a lot of procedures are performed in an operating room
manually, with the use of modern tools and medical devices.

Let's have a look at some of the common types of surgeries, circumstances when surgeries are
necessary, the professionals involved in them and the equipment used. When there has been a
traffic accident and an injured person is brought to the hospital's A&E
department, emergency surgery might be required, i.e. one which has not been planned and
arranged by the hospital's staff. The patient is usually rushed into the operating room where
doctors perform the surgery.

Before doctors begin the operation, they have to scrub up and make sure that the tools &
equipment used are sterile. If necessary, drains are placed to remove blood from wounds. After
the surgery has finished, a suture is applied to hold tissues and skin together and the patient is
taken to the recovery room where his or her health is monitored.

Most kinds surgery are known as reconstructive surgery, because by means of an operation,
surgeons attempt to restore the anatomy, function or appearance of the body. For instance, the
aim of the work of an orthopedic surgeon is to restore the functions of injured bones or muscles,
whereas of a vascular surgeon is to treat the conditions of arteries and veins. Neurosurgery, on
the other hand, involves those surgical procedures that are carried out in order to treat the
disorders affecting constituents of a human nervous system, for example the brain, spinal cord or
nerves.

The saying 'fine feathers make fine birds' is taking on significance nowadays and the way we
look is at least as important as what we say or do, so cosmetic surgery is becoming more and
more popular. People decide to undergo this type of surgery if they want the appearance of a
particular body part, e.g. the nose, ear or breast, to be improved. This type of surgery is always
planned, so there is some prepping to be done before, for example arranging time off work for the
operation and recovery. In most cases local anesthesia is used before the operation.
An anesthesiologist will administer a drug to suppress the feeling of pain. As the drug is normally
liquid, this may be done using a syringe. Firstly the physician disinfects the patients' skin with an
alcohol swab, then aspirates the necessary amount of the liquid and injects it into the body part
which the surgeon will operate on. If the surgery is effective, it will not only make the patient
look better, but also might boost their self-esteem and allow them to lead a happier life.

So far we have classified surgery types according to the function. However, they can also be
classified on the basis of the way an operation is carried out. Keyhole surgery, for example,
which is also called laparoscopic surgery, is a modern technique in which operations are
performed through small incisions. To magnify the surgical elements and provide aid during the
operation, images from inside the body are displayed on monitor screens. On the other hand, its
opposite - laparotomy - involves making a large incision through the abdominal wall.

Because of dynamic technological development, surgery - perceived as a branch of medicine - is

constantly developing. Surgeons use more and more advanced equipment and what was once
thought to be impossible, nowadays can be done. To stay up to date, browse professional
journals, read explanatory articles and watch documentaries, both on TV and online.

14
Operating room equipment

 The operating table in the center of the room can be raised, lowered, and tilted in any
direction.
 The operating room lights are over the table to provide bright light, without shadows,
during surgery.
 The anesthesia machine is at the head of the operating table. This machine has tubes that
connect to the patient to assist him or her in breathing during surgery, and built-in monitors
that help control the mixture of gases in the breathing circuit.
 The anesthesia cart is next to the anesthesia machine. It contains the medications,
equipment, and other supplies that the anesthesiologist may need.
 Sterile instruments to be used during surgery are arranged on a stainless steel table.
 An electronic monitor (which records the heart rate and respiratory rate by adhesive
patches that are placed on the patient's chest).
 The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It
measures the amount of oxygen contained in the blood.

 Automated blood pressure measuring machine that automatically inflates the blood
pressure cuff on patient's arm.
 An electrocautery machine uses high frequency electrical signals to cauterize or seal off
blood vessels and may also be used to cut through tissue with a minimal amount of bleeding.
 If surgery requires, a Heart-lung machine, or other specialized equipment, may be brought
into the room. Heart lung machine takes the temporary control of the heart and lung during
the surgery maintaining the circulation of blood and oxygen content of the body
 Advances in technology now support Hybrid Operating Rooms, which integrate
diagnostic imaging systems such as MRI and Cardiac Catheterization into the operating room
to assist surgeons in specialized Neurological and Cardiac procedures.

The operating room can be an intimidating place, with unfamiliar equipment and people dressed
in strange outfits. If your child visits the hospital prior to surgery, some of the equipment may be
shown to him or her by a child life specialist. A child life specialist is a person that is specially
trained in the growth and developmental needs of children.
One thing your child will need to know is that people in the operating room will be wearing
surgical clothes to help prevent germs from infecting the surgical incision.
The surgical clothing includes the following:
 A protective cap covering their hair
 Masks over their lower face, covering their mouths and noses
 Shades or glasses over their eyes
 Vinyl gloves on their hands
 Long gowns
 Protective covers on their shoes
The surgeon may also wear special glasses that help him or her to see more clearly.
Children need to be aware that the people in the operating room will be wearing this attire,
because they can become frightened if not aware that the staff will be wearing strange clothes. If
your child is able to visit the hospital before surgery, ask if he or she can play with the gloves,
mask, and cap so they are not so scary.

The word ‘Surgery’ is actually derived from a Greek word meaning "hand work"). Surgery is
an ancient medical practice of using operative manual techniques on a patient to discover the

15
 cause of a pathological condition or to help improve the functioning of the body. Nowadays,
surgery is even used to improve appearance. The act of performing an operation is called
a surgical procedure and it invariable involves cutting into the body of a human or animal.
Surgical procedures are performed by surgeons. Today medical science has advanced so much
that there are surgeries to correct almost every disability. Surgical procedures are so refined
that they range from major ones like open heart surgery to minor ones like key-hole surgery
and even laser treatment which does not even require cutting into the body. Common surgical
procedures are those like cardiothoracic surgery, vascular surgery, plastic surgery, pediatric
surgery, colorectal surgery, transplant surgery, surgical oncology, trauma surgery, endocrine
surgery, breast surgery, skin surgery, etc. Check here complete list of Surgical Procedures

Lesson 5

Simple Present Tense

I sing

16
How do we make the Simple Present Tense?
subject + auxiliary verb + main verb

do base
There are three important exceptions:

1. For positive sentences, we do not normally use the auxiliary.

2. For the 3rd person singular (he, she, it), we add s to the main verb or es to the auxiliary.
3. For the verb to be, we do not use an auxiliary, even for questions and negatives.

Look at these examples with the

main verb like:

subject auxiliary verb main verb

I, you, we, they like coffee.

+
He, she, it likes coffee.

I, you, we, they do not like coffee.

-
He, she, it does not like coffee.

Do I, you, we, they like coffee?

?
Does he, she, it like coffee?

Look at these examples with the main verb be. Notice that there is no auxiliary:

subject main verb

I am French.
+
You, we, they are French.

He, she, it is French.

I am not old.
-
You, we, they are not old.

He, she, it is not old.

? Am I late?

Are you, we, they late?

Is he, she, it late?

How do we use the Simple Present Tense?

We use the simple present tense when:

 the action is general
 the action happens all the time, or habitually, in the past, present and future

17
  the action is not only happening now
 the statement is always true

John drives a taxi.

past present future

It is John's job to drive a taxi. He does it every day. Past, present and future.

Look at these examples:

 I live in New York.
 The Moon goes round the Earth.
 John drives a taxi.
 He does not drive a bus.
 We do not work at night.
 Do you play football?

Note that with the verb to be, we can also use the simple present tense for situations
that are not general. We can use the simple present tense to talk about now. Look at
these examples of the verb "to be" in the simple present tense—some of them are
general, some of them are now:

Am I right?
Tara is not at home.
You are happy.

Past present future

The situation is now.

I am not fat.
Why are you so beautiful?
Ram is tall.

past present future

The situation is general. Past, present and future.

18
 This page shows the use of the simple present
tense to talk about general events. But note that
there are some other uses for the simple present
tense, for example in conditional or if sentences,
or to talk about the future. You will learn about
those later.

A. Exercise
Choose the correct option to complete the sentences.

1 Surgeons performs / performing / perform operations.

2 I’m a midwife, I delivers / I’m delivering / deliver babies.

3 The paramedic is unavailable. He responds / ’s responding / respond to an emergency.

4 A Do you work in a hospital? B Yes, I work / do / does.

5 I want / wanting / wants to qualify as a physiotherapist.

6 I like to working / working / work with people.

7 Do you / You are / Are you taking the patient to surgery?

8 I do /’m doing / to do a night shift this week.

Lesson 6
Admitting Patients

A. The purpose of the admission interview is to gather comprehensive information about the patient.
As it is often the first meeting between the patient and the hospital staff. It is an important
opportunity to establish a positive relationship and gain the patient's trust.

Some useful expressions:

Explaining what you’re going to do immediately.
 It's time for me to …
 I just want to …

19
  I would like to interview you
 I am going to assess your health condition
 I need to...
Study and practice the useful expression below

Name What’s your name?

Could I have your name, please?
Date of birth What’s your date of birth?
Could I have your date of birth, please?
Reason for visit What’s wrong?
What’s the matter?
Why did you come here today?
What’s bothering you?
Current medication Are you taking medication?
What medication are you taking?
Do you take any medication?
Medical condition Do you have any medical problem?
Do you have diabetes/high blood pressure/heart
problem, etc…?
Have you ever been diagnosed with …?
Occupation What do you do?
What is your occupation?
Allergies Do you have any allergies to any food/any
Food: medication/anything?
Medication:
Other
Substance use Do you smoke? Yes, how much per day?
Tobacco Do you drink?
Alcohol Do you use drugs?
Other

Other Is there anything else we should know?

Is there anything else you would like to tell us?

B. Reading and Vocabulary

There are three ways to admit a patient to hospital: either as an outpatient, a day patient or an
inpatient. An outpatient needs treatment but not a bed. A day patient needs a bed for a few hours,
but doesn’t need to stay overnight. An inpatient needs at least one overnight stay. Hospitals need
to plan for patient admissions. They have to predict how many beds they will need. It is quite
easy to predict referrals from doctors like General Practitioners, but a larger number of patients
come through A&E, and it is more difficult to plan for them. It is very important to keep accurate
records of patients’ treatment, from admission through to discharge and follow-up. These include
personal details such as marital status, occupation and next of kin, as well as medical history such
as past illnesses and treatments, family history and lifestyle. Medical staff record all treatments,
test results and correspondence. They try to record these things at the time they happen. This is
important, and not only to ensure the correct treatment. Medical records are sometimes used for
research, or in a court of law.

C. Comprehension

According to the text, are the following statements are true (T) or false (F)?

1 Admissions to hospital are all inpatients.

2 There are more emergency admissions than referrals.
3 Hospital records stop at discharge.

20
 4 Personal details are part of medical records.
5 Staff should record treatments at the end of their shift.
6 Only medical staff can look at medical records.

D. Vocabulary

Match the words or phrases 1–7 to a suitable definition a–g.

The first one is done for you.
1 overnight stay a when a patient is sent to hospital
2 admission b normal, everyday behavior
3 referral c treatment after a patient has been discharged from hospital
4 discharge d time as an inpatient
5 follow-up e letters, emails and messages
6 correspondence f the moment when a patient enters hospital
7 lifestyle g when a patient is told they can leave hospital

E. Further vocabulary practice

Underline the correct words in italics to complete the sentences.

The first one is done for you.

1.We don’t need beds for out / in / day patients.

2.Who is your family history / next of kin / occupation?
3.What is your marital status / past illnesses / personal details ?
4.The new patient is a referral / admission / discharge from Cardiology.
5. We need you to come back to the hospital for discharge / follow-up / admission tests.
6. If you don’t stop smoking and drinking so much, your lifestyle / test results / medical history
may kill you.
7. After you sign the discharge / correspondence / record form, you can go home

Lesson 7
Polite Request

A. A request is when we ask someone for something. Since we are asking someone for help, it is
important to be polite.
We must avoid being too direct.

Here are examples of being too direct:

“I want help.”
“Pass me the salt.”
“Can you carry my bag?”

21
These questions are all correct English but they are too direct. These are not polite requests. They
are in fact quite rude. People will be offended because they will think that you are giving them
orders.

In this lesson, you will learn several methods to make a polite request. The first few examples are
to be used in spoken English. The last example is for written English.

Usually, polite request start with Modal Auxiliaries: could, can, would, will, may, might. The
pattern of polite request as follow:

Could/ can/may/ might + I + Bare infinitive +/- Complement

Could/can/ would/ will + You (please) + Bare infinitive +/- Complement

Would + You mind + Gerund +/- Complement

There are 2 kinds of polite requests, those are  formal dan informal polite request.

Could and would usually for formal polite request. Whereas, can dan will used for informal polite

request. The examples of Polite Request as follows:

1. Could I borrow your book?Bisakah saya meminjam bukumu?

2. Could I use your telephone for a moment?Bisakah saya menggunakan telponmu
sebentar?
3. Can you bring me a cup of coffe?Bisakah kamu membawakan saya sedangkir kopi?
4. Can you lend me your dress?Bisakah kamu meminjamkan bajumu?
5. Can you help me please?Bisakah kamu membantu saya?
6. Could you tell me about physics?Biasakah kamu memberitahu saya tentang fisika?
7. Can you send me his number via WhatsApp?Bisakah kamu mengirimkan nomor dia
pada saya lewat WhatsApp?
8. Can you give me a glass of juice?Bisakah kamu memberikan saya segelas jus?
9. Would you like to come to my home tomorrow?Maukah kamu datang ke rumah saya
besok?
10. Would you open the door please?Maukah kamu membuka pintunya?
11. Would you mind returning this pen to Deva?Maukah kamu mengembalikan pulpen ini
pada Deva?
12. Would you mind explaining the material again?Maukah kamu menjelaskan materi ini
lagi? 
13. Would you mind closing the refrigerator?Bisakah kamu menutup kulkasnya?
14. May I sit beside you Sir?Bolehkah saya duduk di samping Anda Pak?
15. May I have salt please?Bolehkah saya meminta garamnya?
16. Will you come to Roni house tonight?Akankah kamu datang ke rumah Roni malam ini?
17. Would you mind collecting my clothes from the wardrobe please?Bisakah kamu
mengambil baju-baju saya di tempat lemari pakaian?
18. Would you mind buying the book for me?Maukah kamu membelikan buku untuk saya?
19. Will you stay here with me?Akankah kamu tetap disini bersamaku? 
20. Would you mind going to the book store please?Maukah kamu pergi ke toko buku?
21. Will you buy me food now?Akankah kamu membelikan makananku sekarang?
22. Would you mind going to the church on Sunday?Maukah kamu pergi ke gereja pada
hari Minggu?
23. Can you wake me at 8 o’clock tomorrow?Bisakah kamu membangunkan saya jam 6
besok?

Read the following situations and requests carefully.

Situation Request

22
1 Mr Zaman wants to find out at a bank counter if Could you find it out from
five taka notes will be banned. The man at the the head office, please?
counter replies with a request.
2 A newcomer in Jhenidah wants to know the way to Could you tell me the way
the post office. to the post office, please?

3 A lady is looking for the principal's room. She asks Excuse me, could you
the college bearer. please show me the
principal's room?
4 A student in class 5 is not feeling well. He goes to Sir, could you please phone
the Headmaster and says, my mother and ask her to
come and take me home?

In the situations given above we notice how polite requests are made to people (strangers,
seniors/bosses etc.). Notice also the use of please with could you…, would you…,

Lesson 8

Simple Future Tense

I will sing

The simple future tense is often called will, because we make the simple future
tense with the modal auxiliary will.

23
How do we make the Simple Future Tense?

The structure of the simple future tense is:

subject + auxiliary verb WILL + main verb

invariable base

will V1

For negative sentences in the simple future tense, we insert not between the auxiliary
verb and main verb. For question sentences, we exchange the subject and auxiliary
verb. Look at these example sentences with the simple future tense:

subject auxiliary verb main verb

+ I will open the door.

+ You will finish before me.

- She will not be at school tomorrow.

- We will not leave yet.

? Will you arrive on time?

? Will they want dinner?

When we use the simple future tense in speaking, we often contract the subject and auxiliary
verb:

I will I'll

you will you'll

he will he'll
she will she'll
it will it'll

we will we'll

they will they'll

For negative sentences in the simple future tense, we contract with won't, like this:

I will not I won't

you will not you won't

24
 he will not he won't
she will not she won't
it will not it won't

we will not we won't

they will not they won't

How do we use the Simple Future Tense?

No Plan

We use the simple future tense when there is no plan or decision to do something
before we speak. We make the decision spontaneously at the time of speaking. Look
at these examples:
 Hold on. I'll get a pen.
 We will see what we can do to help you.
 Maybe we'll stay in and watch television tonight.

In these examples, we had no firm plan before speaking. The decision is

made at the time of speaking.
We often use the simple future tense with the verb to think before it:
 I think I'll go to the gym tomorrow.
 I think I will have a holiday next year.
 I don't think I'll buy that car.

Prediction

We often use the simple future tense to make a prediction about the future. Again,
there is no firm plan. We are saying what we think will happen. Here are some
examples:
It will rain tomorrow.

 People won't go to Jupiter before the 22nd century.

 Who do you think will get the job?

Be

When the main verb is be, we can use the simple future tense even if we have a
firm plan or decision before speaking. Examples:
 I'll be in London tomorrow.
 I'm going shopping. I won't be very long.
 Will you be at work tomorrow?

Note that when we have a plan or intention to

do something in the future, we usually use other
tenses or expressions, such as the present
continuous tense or going to.

25
 Lesson 9
Patient Assessment

Nursing Notes
Inspection, palpation, percussion and auscultation are examination techniques that
enable the nurse to collect a broad range of physical data about patients.
1. Inspection
The process of observation, a visual examination of the patient’s body parts to
detect normal characteristic or significant physical signs
2. Palpation
Involves the use of the sense of touch. Giving gentle pressure or deep pressure
using your hand is the main activity of palpation
3. Percussion

26
Involves tapping the body with fingertips to evaluate the size, borders, and
consistency of body organs and discover fluids in body cavities.
4. Auscultation
Listening to sounds produced by the body

Task 1
Mention what activity you do for each case listed below.

No Activity Techniq
ue
1 Examining patient’s respiratory
2 Inspecting the mouth and throat

3 Asking patient to stand up to find whether there

is scoliosis or
not
4 Pressing her middle finger of non‐dominant
hand firmly against the patient’s back. With
palm and fingers remaining off the skin, the tip
of the middle finger of the dominant hand
strikes

the other, using quick, sharp stroke

Observing the color of the eyes
6 Observing the movement of air through the lungs
7 Testing deep tendon reflexes using hammer
8 Checking the tender areas with her hand
9 Pressing abdomen deeply to check the condition
of underlying
organ
10 Preparing a good lighting, then he observes the
body parts

Task 2. What kind of examination technique?

27
Useful Expressions
Implementation step

Explaining what you are going to do immediately

 Now I am going to …
 It’s time for me to…
 Now I want to…
press your… + (parts of the body) gently
examine your…+ (parts of the body) gently

artery cheeks neck

28
 Instruction
 Would you…?
 Now I want you to…?
remove + your…wig
put off hairpieces

Please + rise your eyebrows

frown your forehead smile

puff your cheeks shrug your shoulder
flex your neck with chin toward
bend your neck, with ear toward shoulder

take a sip of water from this glass

Task 3. Whole class and pair work

 Practice these instructions
 Listen to teacher’s instruction and act them out
 Then, practice these in pairs

1. Raise your eyebrows

2. Close your eyes tightly
3. Frown
4. Smile
5. Puff your cheeks
6. Shrug your shoulder
7. Flex your neck with chin toward
8. Bend your neck, with ear toward shoulder
9. Take a sip of water from this glass

Task 4. Pair work

o Make a complete conversation on acts of assessing head, face and neck
o Use the expression above

29
 Lesson 9
Pre Operation

 Before performing a procedure, it is important to receive consent from the patient:

- Ask permission to make an examination

- Explain what you intend to do before doing it

- Ask the patient if he/she has questions & answer them

- Check that the patient has understood

- Obtain permission to proceed

- Be mindful of the comfort and privacy of others.

 With invasive and surgical procedures, it is particularly important to give a full explanation of what
you are proposing, your reasons for wishing to undertake the procedure and what you hope to find
or accomplish.

 Ensure that you use language that can be understood; draw pictures and use an interpreter, if
necessary.

 Allow the patient and family members to ask questions and to think about what you have said.

 It may be necessary to consult with a family member or community elder who may not
be
present; allow for this if the patient’s condition permits.

 If a person is too ill to give consent (for example, if unconscious) and their condition will not
allow further delay, you should proceed, without formal consent, acting in the best interest of the
patient.

 Record your reasoning and plan.

 Informed consent means that the patient and the patient’s family understand what is to take place,
including the potential risks and complications of both proceeding and not proceeding, and have
given permission for a course of action.

 Be attentive to legal, religious, cultural, linguistic and family norms and differences.
30
  Some hospitals require patients to sign a document indicating that the surgical procedure and
potential complications have been explained and that permission to proceed has been granted.

 This paper is then included in the patient’s record.

 If this is not a formal requirement in your hospital, document the conversation in which consent was
given and include the names of people present at the discussion.

 Informed consent means that the patient and the patient’s family understand what is to take place,
including the potential risks and complications of both proceeding and not proceeding, and have
given permission for a course of action.

 It should be a choice made free from coercion.

 Our duty as professionals to provide service and care can come into conflict with our personal
opinions. It is important to be aware of these feelings when they occur and to understand where
they are coming from.

If we are asked to care for someone who is alleged to have committed a crime, it is not our responsibility to
administer justice.

 However, it is our responsibility to provide care. This can be difficult, but it is important to
recognize that:
- Our job is not to judge, but to provide care to all without regard to social status or any
other considerations. By acting in this way, we will be seen to be fair and equitable by the
community we serve.

Record Keeping

 Admission note/preoperative note

 Operating room records usually includes:
- Patient identity
- Procedure performed

- Persons involved
- Complications.

 Delivery book

 The operative note

31
 Postoperative notes can be organized in the “SOAP” format:

Subjective How the patient feels

Objective Findings on physical examination, vital signs and laboratory results
Assessment What the practitioner thinks Plan Management plan; this may also
include directives which can be written in a specific location as “orders”.

 Discharge note: record:

- Admitting and definitive diagnose

- Summary of patient’s course in hospital

Instructions about further management as an outpatient, including any medication and the length of
administration and planned follow-up. 

Hand Washing Technique

32
When scrubbing (Figure 2.4):

- Remove all jewellery and trim the nails

- Use soap, a brush (on the nails and finger tips) and running water to clean
thoroughly around and underneath the nails
- Scrub your hands and arms up to the elbows
- After scrubbing, hold up your arms to allow water to drip off your elbows
- Turn off the tap with your elbow.

33
After scrubbing your hands:

- Dry them with a sterile towel and make sure the towel does not
become contaminated.
- Hold your hands and forearms away from your body and higher than your
elbows until you put on a sterile gown and sterile gloves.

Always wash your hands after removing your gloves

Scrubbing and gowning

 Before each operation, all members of the surgical team – that is,
those who will touch the sterile surgical field, surgical instruments or
the wound – should scrub their hands and arms to the elbows.

 Scrubbing cannot completely sterilize the skin, but will decrease the
bacterial load and risk of wound contamination from the hands.

 Every hospital should develop a written procedure for scrubbing that

specifies the length and type of scrub to be undertaken.

 It is usual that the first scrub of the day is longer (minimum 5

minutes) than any subsequent scrubs between consecutive clean
operations (minimum 3 minutes).

 Surgical gloves prevent transmission of HIV through contact with

blood, but there is always the possibility of accidental injury and of a
glove being punctured.

 Promptly change a glove punctured during an operation and rinse your

hand with antiseptic or re- scrub if the glove has leaked during the
puncture.
 Patient safety is of primary concern; do not compromise it. Change
your gloves only when it is safe for the patient

34
35
 Lesson 10
Post Operation

Postoperative Management

If the patient is restless, something is wrong.

Look out for the following in recovery:

 Airway obstruction
 Hypoxia
 Haemorrhage: internal or external
 Hypotension and/or hypertension
 Postoperative pain
 Shivering, hypothermia
 Vomiting, aspiration
 Falling on the floor
 Residual narcosis.

The recovering patient is fit for the ward when:

 Awake, opens eyes

 Extubated
 Blood pressure and pulse are satisfactory
 Can lift head on command
 Not hypoxic
 Breathing quietly and comfortably
 Appropriate analgesia has been prescribed and is safely established.
Post Operative Pain Relief

 Pain is often the patient’s presenting symptom. It can provide useful clinical
information and it is your responsibility to use this information to help the
patient and alleviate suffering.

 Manage pain wherever you see patients (emergency, operating room and on
the ward) and anticipate their needs for pain management after surgery and
discharge.

 Do not unnecessarily delay the treatment of pain; for example, do not

transport a patient without analgesia simply so that the next practitioner can
appreciate how much pain the person is experiencing.

36
 Pain management is our job.

Pain Management and Techniques

 Effective analgesia is an essential part of postoperative

management.
 Important injectable drugs for pain are the opiate analgesics. Nonsteroidal
anti-inflammatory drugs (NSAIDs), such as diclofenac (1 mg/kg) and
ibuprofen can also be given orally and rectally, as can paracetamol (15
mg/kg).
 There are three situations where an opiate might be given:
- Preoperatively
- Intraoperatively
- Postoperatively.
 Opiate premedication is rarely indicated, although an injured patient in
pain may have been given an opiate before coming to the operating room.
 Opiates given pre- or intraoperatively have important effects in the
postoperative period since there may be delayed recovery and
respiratory depression, even necessitating mechanical ventilation.
 Short acting opiate fentanyl is used intra-operatively to avoid this
prolonged effect.
 Naloxone antagonizes (reverses) all opiates, but its effect quickly
wears off.
 Commonly available inexpensive opiates are pethidine and
morphine.
 Morphine has about ten times the potency and a longer duration of action
than pethidine. (continued next page)
 Ideal way to give analgesia postoperatively is to:
- Give a small intravenous bolus of about a quarter or a third of the
maximum dose (e.g. 25 mg pethidine or 2.5 mg morphine for an
average adult)
- Wait for 5–10 minutes to observe the effect: the desired effect is
analgesia, but retained consciousness
- Estimate the correct total dose (e.g. 75 mg pethidine or 7.5 mg
morphine) and give the balance intramuscularly.
- With this method, the patient receives analgesia quickly and the
correct dose is given.
 If opiate analgesia is needed on the ward, it is most usual to give an
intramuscular regimen:
 Morphine:
– Age 1 year to adult: 0.1–0.2 mg/kg
– Age 3 months to 1 year: 0.05–0.1 mg/kg
 Pethidine: give 7–10 times the above doses if using pethidine.
 Opiate analgesics should be given cautiously if the age is less than 1
year. They are not recommended for babies aged less than 3 months
unless very close monitoring in a neonatal intensive care unit is
available.

Anaesthesia & Pain Control in Children

 Ketamine anaesthesia is widely used for children in rural centres (see

pages 14–14 to 14–21), but is also good for pain control.

37
  Children suffer from pain as much as adults, but may show it in
different ways.
 Make surgical procedures as painless as possible:
- Oral paracetamol can be given several hours prior to
operation
- Local anaesthetics (bupivacaine 0.25%, not to exceed 1 ml/kg)
administered in the operating room can decrease incisional pain
- Paracetamol (10–15 mg/kg every 4–6 hours) administered by
mouth or rectally is a safe and effective method for controlling
postoperative pain
- For more severe pain, use intravenous narcotics (morphine
sulfate 0.05–0.1 mg/kg IV) every 2–4 hours
- Ibuprofen 10 mg/kg can be administered by mouth every 6–8
hours

Codeine suspension 0.5–1 mg/kg can be administered by mouth every 6 hours, as

needed.

38