LESSON 4 NEUROLOGICAL UNIT 神經科

1. LESSON 4NEUROLOGICAL UNIT神經科 周肇茂 教授 口腔醫學院牙醫學系 分機7025 E-mail:pro11sth@kmu.edu.tw

2. Learning Goals Case Information: CVA (cerebrovascular accident) 腦血管意外 Scene I Admission Interview 入院問診 Scene II Hospitalization 住院治療 Scene III Discharge Teaching 出院衛敎 參考書籍/Nursing English for Pre-Professionals. 作者/ LiveABC互動英語教學集團 出版社/ 希伯崙股份有限公司

3. ESP Focus Radial nerve 橈神經 Median nerve 正中神經 Ulnar nerve 尺神經 Sciatic nerve 坐骨神經 Brain 腦 Cervical- 8 nerves 頸神經- 8對 Thoracic- 12 nerves 胸神經- 12對 Lumbar- 5 nerves 腰椎神經- 5對

4. ESP Focus Sacral- 5 nerves 薦骨神經- 5對 Cerebrum 大腦 Frontal lobe 額葉 Motor cortex 運動皮層 Sensory cortex 感覺皮層 Parietal lobe 頂葉 Temporal lobe 顳葉 Occipital lobe 枕葉

5. ESP Focus Cerebellum 小腦 Brain Stem 腦幹 Spinal cord 脊髓 Olfactory nerve (I) 嗅神經 Optic nerve (II) 視神經 Oculomotor nerve (III) 動眼神經 Trochlear nerve (IV) 滑車神經 Trigeminal nerve (V) 三叉神經

6. ESP Focus Abducens nerve (VI) 外旋神經 Facial nerve (VII) 顏面神經 Acoustic nerve (VIII) 聽神經 Glossopharyngeal nerve (IX) 吞咽神經 Vagus nerve (X) 迷走神經 Accessory nerve (XI) 副神經 Hypoglossal nerve (XII) 舌下神經

7. Admission Interview Mr. Roberts is admitted to the hospital with a headache, weakness in his right extremities, and a diagnosis of CVA. N: nurse P: patient N: Hello, I’m Your nurse. P: Oh, I see. N: How is your headache? P: It’s still bothering me. N: Can I take your blood pressure? P: Sure. N: Your blood pressure is 195/110. P: 195/110? N: Yes it’s high. P: No wonder I have a headache.

8. Admission Interview N: I’ll insert an IV line and start the medication for you. Hopefully, your headache will get better. P: All right. N: Do you have any other discomfort besides this? P: No. But I feel frustrated because now I need to be helped with dialy activities. N: I understand. Don’t worry. We’ll arrangerehabilitation for you. P: Will that help? N: Yes I’ll come to pull the needle out after the IV is finished. Please let me know if there is any pain or swelling at the site.

9. Word Bank Headache 頭痛 Weakness 虛弱；衰弱 Diagnosis 診斷 No wonder 難怪 Insert 插入 Hopefully 但願；滿懷希望地 Discomfort 不適；不舒服 Frustrated 挫折的

10. Word Bank Daily 每天的；日常的 Arrange 安排 Needle 針 Swelling 腫大；膨脹

11. ESP Focus • Neurological 神經學的 • Extremilty 手足；四肢(常以複數形) • CVA(cerebrovascular accident) 腦血管意外；中風 (在此指 stroke) • IV = intravenous 靜脈注射 • Rehabilitation 復健 • Site 患部；部位

12. Patient Assessment The nurse is assessing Mr. Roberts’ level of consciousness and muscle strength. N: Good morning. Let me check your pupils. P: OK. N: I need to check your muscle strength too. Please raise your arms. P: I’m too weak to raise them. N: Just try your best. Now try to raise your legs. P: (raises his legs) I feel useless now. N: That’s all right. You’ll make progress by exercising. How is your rehabilitation going? P: It’s OK, but doing it two hours a day is tiring. N: You’ll get better as long as you are willing to make an effort. P: I know. I just feel very tired.

13. Patient Assessment N: Are you making any progress in your muscle strength? P: There has been little progress, to be honest. But I really hope I can go home soon. N: Recovery takes time. Don’t ge discouraged. Just follow the instructions of the physcial therapist. P: Thank you for the encouragement. N: You’re welcome. Now it’s time to go to the rehabilitation department.

14. Word Bank Assessment 評估 Useless 無能的；沒用的 Progress 進步；進展 Be willing to 願意…… Effort 努力 To be honest 老實說 Recovery 復原；恢復 Discourage 氣餒的；沮喪的 Encouragement 鼓勵

15. ESP Focus Muscle Strength 肌肉強度 Pupil 瞳孔 Physical therapist 物理治療師 (PT)

16. Discharge Teaching Mr. Roberts has been hospitalized for 14 days, and is ready for discharge tody. N: Mr. Roberts, your blood pressure is 140/88. P: Does that mean I’m making progress? N: Yes. After you leave the hospital, be sure to take your blood pressure every day to monitor the changes. P: I will. But what should I do if my blood pressure goes up again? P: Come back to the hospital if you find your BP going up or if you don’t feel well. P: I will. Is there anything else I should remember? N: Yes, you also need to be careful about your diet. Don’t eat anything too salty or greasy. P: I know, but greasy food is tempting.

17. Discharge Teaching N: (laughs) True. But a healthy lifestyle is as important as your medication. P: Yes, indeed. N: Will you remember to take your medicine regularly and not stop without conculting your doctor first? P: Certainly. I’ll take my medicine on schedule and pay attention to my blood pressure. N: By the way, please go to the pharmacy to get your medicine before you leave. P: Don’t I have to go to the billing office first? N: That’s right. Go to the billing office first, then the pharmacy.

18. Word Bank Be sure to 一定；切記 Monitor 監控；監視 Careful 注意的；小心的 Greasy 油膩的 Tempting 誘人的；吸引人的 Indeed 確實；的確 Consult 諮詢；請教 Certainly 當然；必定 On schedule 按照預定時間

19. ESP Focus Pharmacy 藥房 Billing office 批價處

20. Summary Page Talking about CVA (腦血管意外：腦中風) Assessing Muscle Strength Explaining Discharge Plans

21. LESSON 5Orthopedic Unit骨科 周肇茂 教授 口腔醫學院牙醫學系 分機7025 E-mail:pro11sth@kmu.edu.tw

22. Learning Goals: Case Information: Spinal Stenosis Syndrome 脊椎狹窄症候群 Scene I Admission Interview 入院問診 Scene II Post-Op Assessment 術後評估 Scene III Discharge Teaching 出院衛敎 參考書籍/Nursing English for Pre-Professionals. 作者/ LiveABC互動英語教學集團 出版社/ 希伯崙股份有限公司

23. ESP Focus Skull 頭蓋骨 Maxilla 上頷骨 Mandible 下顎 Clavicle 鎖骨 Sternum 胸骨 Elbow 肘 Femur 股骨 Scapula 肩胛骨

24. ESP Focus Rib 肋骨 Vertebra 脊椎骨 (複數為vertebrae) sacrum 薦骨 Wrist 腕關節 Knee 膝；膝部

25. Devisions of the Skeleton • The Vertebral Column 脊柱 • Cervical region 頸部 • Thoracic region 胸部 • Lumbar region 腰部 • Sacral region 薦骨 • Coccyx 尾骨 • Intervertebral disc 椎間盤 • The Upper Extremities • Humerus 肱骨 • Radius 橈骨 • Ulna 尺骨

26. Devisions of the Skeleton • The Hand • Carpal • Metacarpal • Proximal/middle/distal phalanx 近節/中節/末節指骨 (phalanx複數可拼成phalanxes或phalanges) • The Lower Extremities • Femur 股骨 • Patella 膝蓋骨 • Fibula 腓骨 • Tibia 脛骨

27. Devisions of the Skeleton • The Foot • Talus 踝骨 • Navicular 舟骨 • Calcaneus 跟骨 • Metatarsal 蹠骨 • Proximal/middle/distal phalanx 近節/中節/末節指骨

28. Admission Interview Mr. Williams is at the hospital. He feels a lot of pain in his lower extremities. N: Nurse P: Patient N: What brought you to the hospital, Mr. Williams? P: My right leg aches, and I can’t walk normally. N: Where exactly does it hurt in your right let? P: In my thigh and buttock (touches his right buttock). N: Can you describe the pain? P: It’s a dull sort of pain. N: Is there anywhere else that you feel uncomfortable? P: I feel numb if I walk for more than 10 minutes. N: How long have you been like this? P: About half a year. At first, it’s soreness. Then it changes to numbness when I walk.

29. Admission Interview N: Have you seen a doctor? P: Yes, the doctor at the clinic has told me there is serious nerve compression, and has suggested an operation. N: All right. So you know there is going to be an operation? P: Yes. I was told about it. N: OK. Let me check your muscle power. Lift your feet and push against me. P: Like this (pushes with his right foot, then his left)? N: Uh huh. Your right foot is weaker than your left. Now, let me orient you to the hopital.

30. Word Bank Ache (持續性)疼痛 Normally 正常地 Exactly 切確地；恰好地 Dull (疼痛) 隱約的；遲鈍的 Numb 失去感覺的；麻木的 Soreness 酸痛 Operation 手術 Lift 舉起；抬起 Against 對著；相反 Orient 使…適應、熟悉環境

31. ESP Focus Orthopedic 骨(外)科的 Thigh 股；大腿 Buttock 屁股 Nerve compression 神經壓迫

32. Post- Op Assessment The nurse is explaining post-op care to Mr.Williams and his brother. N: Nurse P: Patient B: Brother N: Your blood pressure and heart rate are normal. How do you feel now? P: So far so good. N: This PCA machine will automatically give you an analgesic. P: What’s that? N: It’s painkiller. If you feel a lot of pain, just press this button. (The patient nods as the nurse demonstrates.) N: Now in order to expand your lungs, you have to start breathing deeply and cough more effectively. P: Am I doing it the right way (breathes deeply)? N: Yes, Well done. And remember to take deep breaths whenever possible.

33. Post- Op Assessment P: I will. N: (turns to Mr. Williams’ brother) Watch carefully. This is how we keep the spine straight when rolling over. B: I see. Put one hand over the shoulder, and the other on the buttock, right? N: Exactly. Be careful not to pull on the drainage tube when you help him roll over. B: I’ll be careful. N: And do you know how to help him cough up sputum? B: Yes, I have learned chest percussion. N: Good. (checks the dressing) The dressing is dry. We’ll keep an eye on the drainage.

34. Word Bank Automatically 自動地 Painkiller 止痛藥 Nod 點頭 Demonstrate 示範操作 Expand 擴大 Roll 滾動 (roll over 翻身) Keep an eye on 注意

35. ESP Focus Heart rate 心跳速率 PCA (patien-controlled analgesia) 病患自控式止痛法 Analgesic 止痛劑 Spine 脊椎 Drainage tube 引流管 Chest percussion 拍痰；胸部扣擊 Dressing 敷料；包紮用品

36. Discharge Teaching The nurse is preparing Mr. Williams for discharge. N: The wound is healing very well. But there is still some discharge on the drainage site. P: Do I have to change the dressing after I get home? N: The wound will be covered with tape. So, there’s no need to change the dressing unless there’s discharge. P: Uh huh. Is there anything else I should remember? N: Yes. You have to examine the incision for any unusual symptoms every day. P: What do you mean by unusual symptoms? N: Well, such as redness, swelling, heat, and pain. P: I see. And how do I change the dressing if necessary? N: The swab goes outward from the center of the wound. And you have to cover the wound with gauze.

37. Discharge Teaching P: Maybe I should write that down. N: Good ides. You’ll also get a bottle of aquatic-beta iodine before you’re discharged. P: Can I take a shower after I go home? N: We recommend that you take a sponge bath for the first two weeks. You must keep the wound dry. P: Are there any restrictions on my diet? N: Not really. But food high in protein and vitamins will help the wound to heal.

38. Word Bank Heal (傷口) 癒合；痊癒 Unless 除非 Examine 檢查；診察 Unusual 異常的；奇特的 Redness 紅色 Outward 向外 Recommend 建議 Restriction 限制

39. ESP Focus Incision 手術切口 Swab 棉枝 Gauze 醫用紗布 Aquatic-beta iodine 優碘 Sponge bath 海綿擦浴 Protein 蛋白質 Vitamin 維他命；維生素

40. Summary Page Talking about Spinal Stenosis Syndrome (脊椎狹窄症候群) Assessing Post-Op (術後) Recovery Explaining Discharge Plans

41. Urological Unit泌尿科 周肇茂 教授 口腔醫學院牙醫學系 分機7025 E-mail:pro11sth@kmu.edu.tw

42. Learning Goals Case Information: Benign Prostatic Hyperplasia良性攝護腺肥大 Scene I Admission Interview 入院問診 Scene II Post-Op Care 術後照顧 Scene III Discharge Teaching 出院衛敎 參考書籍/Nursing English for Pre-Professionals. 作者/ LiveABC互動英語教學集團 出版社/ 希伯崙股份有限公司

43. ESP Focus Kidney 腎臟 Ureter 輸尿管 Bladder 膀胱 Sphincter 括約肌 Urethra 尿道 Pubic bone 恥骨 Prostate 前列腺 Rectum 直腸

44. ESP Focus Vas deferens 輸精管 (ductus deferens) Penis 陰莖 Anus 肛門 Testis (複數為testes) Ovary 卵巢 Uterus 子宮 Vagina 陰道

45. Admission Interview Mr. Thompson complains of difficulty in urination. He’s admitted to the hospital for treatment. N: nurse P: patient N: Mr. Thompson, how are you feeling tody? P: I’m having difficulty urination. N: What do you mean by having difficulty urination? P: I urinate frequently, but very small amouts each time. It’s like water dripping. N: Is that all? P: No, I urinate often during the night too. N: How long have you been like this? P: About half a year. It has been bothering me a lot.

46. Admission Interview N: Did Dr. Whitley tell you that you have an enlargedprostate? P: Yes, he told me about it after the anal examination. N: Did he also tell you about the operation? P: Yes. Dr. Whitley told me it’s tomorrow. N: Good. You’ll be NPO after midnight. P: What did you just say? NPT? N: Yes, it means nothing by mouth. No eathing or drinking after midnight. P: OK. I won’t eat or drink anything

47. Word Bank Complain of 抱怨；訴說(病情)；主訴 Urination 排尿 Frequently 頻繁地；屢次地 Drip 滴水 Midnight 午夜

48. ESP Focus Urological 泌尿的 Difficulty in urination 排尿困難 Enlarged prostate 攝護腺肥大 Anal examination 肛門檢查；肛診

49. Post-Op Care Mr. Thompson is resting in bed after returning from the recovery room. N: nurse P: patient N: Mr. Thompson, you have a catheter inserted now. It’ll drain your urine. P: Why do I need a catheter? N: The balloon inside it will help stop the bleeding. P: Oh, I see. N: The catheter is also necessary for a normal saline irrigation. This helps prevent blood clots. P: Blood clots? N: Yes, they might block the urinary tract. P: Should I be worried?

50. Post-Op Care N: No, but you need to be on bed rest until the catheter is removed. P; All right. N: So, how are you feeling now? P: I feel OK. (The nurse observes the urine flow and color.) N: The urine is flowing smoothly now. And it’s a light red color. P: Is light red normal? N: Yes. And if you notice that the urine turns red and thick, please let us know. It could mean there is more bleeding. P: I’ll pay attention to it. When can I start eating? N: You may start eating now. And please drink more water to help the flow of urine.