MODULE 3 Examination

Conducting a Physical

Photo compliments of Microsoft clipart

Module Description and Content Goals:

Given topics on physical examinations and objective data collection; texts that are varied and of a specialized and medical nature, which include information presented from dialogues and other sources (e.g. photographs, drawings, reference text /research information), the participant will use English with 70 % accuracy to: 1. Identify and use words and expressions health care workers use when examining a patient (Words and Expressions to Know). 2. Give instructions using imperatives and modals of polite requests . (Grammar, Speaking) 3. Practice how to give instructions in a clear and polite manner (Words and Expressions to Know, Listening, Speaking). 4. Use order transitional words when describing a process. (Grammar, Writing) 5. Listen for specific information. (Listening) 6. Record vital signs using typical abbreviations. (Writing) 7. Role play a dialogue where a health care worker is taking vital signs. ( Speaking) 8. Write a narrative description of a patients problems summarizing his/her symptoms and the doctors findings. (Writing)

9. Differentiate between verbal and non-verbal communication. (Communication Tip) 10.Identify ways to reassure an anxious or modest patient. (Communication Tip) 11.Role play a dialogue where a health care worker is preparing a patient for abdominal examination. (Speaking) 12.Research the medical condition of hypertension and give an oral presentation about it. (Speaking)

MODULE 3 H3:1 WORDS & ESPRESSIONS TO KNOW:

ANSWER KEY

A. When examining a patient, you should: I. Explain to the patient what you are going to do in a clear and simple way. You can start using the following expressions: I am going to examine your (throat, skin, neck, chest, belly, etc.) so I can find out whats causing this, whats going on with you, etc. Id like to What we are going to do today is. I will ask you to Are you ready? OK? Complete the sentences providing your own examples: What we are going to do today is Answers will vary

________________________________________ ___________________________________________________________________________________ _ I am going to _________________________________________________________________________ I will ask you to _______________________________________________________________________ II. Give your instructions in a clear but polite manner.

GRAMMAR NOTE I: The simple form of a verb is used to give instructions or make requests. E.g. Remove your clothes and put on this gown, please. Please stick your tongue out for me. Notice that there is no subject because you (the person being asked to do something) is obvious. Use please to make a request more polite. Please can go either at the beginning or at the end of a sentence. However, you will make your requests a lot more polite if you use them with such modals as CAN/COULD/WILL/WOULD. E.g. Can/Could/Will/Would you stick your tongue out? - is more polite than Stick your tongue out. COULD and WOULD are considered to be more polite than CAN and WILL. Again, the word please makes the request even more polite. The two possible positions of please in requests are either between you and the verb or at the end of a sentence. E.g. Would you please lie down so I can examine your belly? Can you fold your arms across the chest, please? It is best to start an examination making the polite requests with modals. After the first few polite requests, direct instructions with imperatives can be used. E.g. Could you please remove your shirt and put on this gown? Would you lie down on the examination table? Rest your hands by your side, please. Please breathe through your mouth and take slow, deep breathes. Soften these instructions using the modals of polite request CAN, COULD, WILL or WOULD. Follow the example: 1. Turn your head this way, please. way, please? 2. Open wide, please. Say Ahh. Say Ahh. 3. Take off your shoes and socks, please. socks, please? 4. Roll up your sleeve for me, please. for me? 5. Tilt your head back a little more, please. little more, please? Could you turn your head this Can you open wide, please? Will you take your shoes and Would you roll up your sleeve Could you tilt your head back a

6. Take off your clothes and put on this gown, please.

Would you take off your clothes an

Now think about when each of these requests is made. Match them with the exa procedure they are used for. Follow the example:

Auscultation 6. Feet examination Nose examination Throat examination Taking blood pressure Ear examination

3. 5. 2. 4. 1.

III.Explain to your patient each step of the examination. Encourage him/her to ask questions about the procedures you are performing. This will help to alleviate anxiety. Use the following phrases: Im just going to First, Ill Then Ill Now Im going to Youll feel Thats it. You did great. GRAMMAR NOTE II: Such words as first, then, next, after that, finally are the connecting words that show the order of steps in the procedure or the order of events in the narrative. Try to use them when you describe some process. They will make your explanation clear, logical and easy to follow for your patients or colleagues. Then, next, and after that are interchangeable; that is, after first and before finally, they can be mixed up in different orders.

PUNCTUATION NOTE: When describing the order of events in writing, use comma when first, next, after that and finally come at the beginning of a sentence. Note that no comma is necessary after then. Here are the instructions on how to take vital signs. Number them in the order they should be given from 1 to 5. Then add the connecting words to each step. The first one is done for you.

2. 4. 5. 1. 3. IV.

Next, After that, Finally, First, Then

take the patients temperature. check his or her blood pressure. tell the patient to wait for the doctor. weigh the patient on the scale. take his or her pulse and respirations.

At the end of an examination, share your findings with the patient:

Everything looks normal. I havent found anything to suggest any problems. One possibility is it could be what we call Well, I am fairly certain youve got a B. Verbs used in instructions given during examinations: bend down open your mouth stand straight/stand up breath in/out pull/push as hard as you can take off your shoes follow my fingertip with your eyes stick your tongue out turn your head to the left flex your foot raise your leg turn on your side lie on your side/back, lie on the bed, lie down roll over/roll on to your back/front tilt your head back look straight ahead/look at something sit/sit up relax Check the correct word combinations in the table below. Follow the example: raise turn tilt relax stretch bend flex your foot x x x x x your leg x x x x x x your head x x x x your shoulder x

C. To perform a thorough, complete assessment of a patient, four basic techniques are used: inspection palpation auscultation percussion

Match each technique with its meaning. Write it next to the definition.

a. tapping the surface of a body part with a finger percussion

b. listening to the sounds of organs with a stethoscope c. careful examination of a person d. touching with hands and feeling for texture, shape temperature, moisture, etc.

auscultation inspection palpation

D. Complete the table with the words from Part C. Put a stress mark in front of the stressed syllable in each word. Some words have two stresses: primary and secondary. The first one in the table is a good illustration of that.
Noun ,examination assessment ,auscultation inspection palpation percussion examine assess auscultate inspect palpate percuss Verb

Now listen to these words and repeat them. MODULE 3 H3:2 ANSWER KEY

WORDS, EXPRESSIONS AND ABBREVIATIONS TO KNOW:

A. Dr. Howell is going to examine Ms. Sandler and measure her vital signs. Repeat the words he will be using during the examination:

height weight stethoscope thermometer temperature to examine gown pulse to get dizzy lightheaded respiration rate rate breath breathe to get woozy Fahrenheit

heart

B. The physician will be recording his patients measurements in the chart that has some abbreviations and symbols. Try to figure these abbreviations and symbols out by doing this matching activity: 1. T 2. P 3. R 4. BP 5. Ht 6. Wt 7. F 9. foot 6. weight 7. Fahrenheit 2. pulse 3. respiration 1. temperature 5. height

8. lb 9. 10.

4. blood pressure 10. inch 8 . pound

LISTENING.

C.

Listen to this part of the consultation and fill in Dr. Howells notes. Sandler T: 68 17 90/60 53 135 lb AGE: 45 97.6 F SEX: Female

PATIENT: Susan DOB 4/30/63 Vital signs: P: R: BP: Ht: Wt:

What was the order in which Dr. Howell took Ms. Sandlers vital signs? Is this the proper order in which this part of physical assessment should be performed? Validate your answer. Yes, the vital signs were taken in the proper order. Dr. Howell measured Ms. Sandlers temperature first; then she checked her heart rate and respiratory rate. Finally, she took her blood pressure. Measuring the temperature first puts the patient at ease and requires him/her to remain still for several minutes. This reduces anxiety and any kind of activity and allows to get more accurate readings of pulse, respiration and blood pressure.

D. Listen to this examination again. Pay attention to the forms the physician is using to give instructions to his patient. Fill in the blanks with these forms . Dr. Howell: Well, Ms. Sandler, if I could just examine you. Then we will talk more about how to deal with your condition. First, Ill take your measurements and then Ill check your vital signs. Usually its my nurse who is doing this, but since I havent seen you for such a long time, you get special treatment today. Ms. Sandler: OK. Dr. Howell: Well, lets measure your height and weight. Will you please stand on the scale? Ms. Sandler: Should I take off my shoes? Dr. Howell: Yes, please. So, you weigh 135 pounds and you are 5 feet 3 inches tall.

Now Im going to wash my hands, get a stethoscope and take your vital signs. Please have a seat on the exam table. Ill be right with you. OK. Lets take your temperature first. Open your mouth wide so I can put the thermometer underneath your tongue. Ms. Sandler: Whats my temperature, doctor? Dr. Howell: Its 97.6. Ms. Sandler: Is that too low? Dr. Howell: Its a little on the low side, but its within the norm. Next well check your pulse. Your heart rate is 68 and your respiration rate is 17. You are doing great so far. I just need to measure your blood pressure. Please roll up your sleeve for me. Its 90 over 60. Ms. Sandler: I think that one is low, too. Dr. Howell: Do you ever get lightheaded? Ms. Sandler: You mean dizzy? No, not really. Dr. Howell: Then I wouldnt worry about it. Believe me its better to have the blood pressure low than high. Ms. Sandler: Now that I think about it, doctor, I do feel a little woozy when I dont eat. Dr. Howell: Do you feel better after you eat? Ms. Sandler: Yes, it is usually gone 10 minutes after I have a meal. I just need to eat. Dr. Howell: Yes, diet is very important to your health, and I thats something else I wanted to talk to you about after Im done with the examination. Finally, I would like to listen to your heart and examine your belly. Could you remove your shirt and put on this gown? In the meantime, Ill go and get some literature about depression, you know, some helpful tips on how to deal with it. I will also bring some pamphlets on proper nutrition. Ill be right back. E. Compare your notes with a partner. Listen to the conversation again. Identify the phrases the physician uses to explain each step of the procedure. Follow the example: First, Ill take your measurements and then Ill check your vital signs.____________________________________ Lets measure your height and weight.____________________________________________________________ Now Im going to wash my hands, get a stethoscope and take your vital signs.____________________________ Lets take your temperature first. Open your mouth wide so I can put the thermometer underneath your tongue. Next well check your pulse._____________________________________________________________________ I just need to measure your blood pressure.

_____________________________________________________ Finally, I would like to listen to your heart and examine your belly.______________________________________

F. Now read the dialogue with your partner using proper pronunciation and

intonation.

Photo compliments of Microsoft clipart

MODULE 3 H3:3

ANSWER KEY

A. SPEAKING: Role-play with a partner. Take turns being a health care worker and the patient. Refer to the conversation in H3:2. 1. Greet the patient as he or she enters the waiting room. 2. Measure the patients height and weight. 3. Escort the patient to the exam room. 4. Take the patients vital signs. 5. Tell the patient what to do to get ready to see the doctor. Answers will vary.
B. WRITING: Case notes are kept after each consultation. Based on the three dialogues between Dr. Howell and Ms. Sandler in Modules 1,2 and 3, write the notes about Ms. Sandler. Describe Ms. Sandlers case using objective terminology. Include the subjective data the clients self-report of signs and symptoms. Write your observations and findings in the form below. Add your own details as not all the information about Ms. Sandler was elicited.

NURSES NOTES
DATE TIME PATIENT: SUSAN SANDLER EX: Female Vital Signs: T: Ht: Allergies: Chief complaint: Past medical history: Medication: Substance use: Family history : Social history Subjective: P: Wt: DOB 4/30/63 AGE: 45

R:

BP:

Objective:

Assessment:

Plan:

MODULE 3 H3:4

ANSWER KEY

A. COMMUNICATION TIP: Sometimes, people feel anxious and modest during the

examination, especially if they anticipate discomfort or have the fear that the examiner will find something seriously wrong. Look for verbal and non-verbal cues to find out various concerns of the client. Verbal cues are words or phrases that indicate physical or emotional problems. E.g. Does it hurt, doctor? I am in excruciating pain. Doc, am I going to be all right? Nonverbal cues can also suggest your clients anxiety and distress. They can be discovered by observing his or her facial expressions, gestures, posture, eye contact, and tone of voice. E.g. Your client is nervous. His/her legs and hands are trembling. The client has tears in his/her eyes. His face grimace shows that he is in pain. It is important to notice and respond to all verbal and non-verbal cues and alleviate your patients anxiety by explaining each aspect of the procedure (see Words and Expressions, # 3). Encourage the patient to ask questions. Use the following phrases to reassure the patient if necessary:

You might feel a little bit of discomfort. This might hurt a little, but Ill be quick. Many people feel an uncomfortable pinching, but it is not too bad. Tell me if it hurts. Let me know if its sore. It wont take long. It will be over very quickly. You are doing great. B. SPEAKING: You are about to perform a physical examination of the patients abdomen. Prepare the patient for this procedure. Talk him through each step of the examination. Use the following cues: 1. Tell the patient what you are going to do. 2. Ask him to empty the bladder before beginning the examination. 3. Instruct the client to remove clothes and to put on a gown. 4. Tell your patient to lie down. 5. Instruct him to cross his arms across the chest or rest them by the sides.

6. Offer him a pillow under his head for comfort. 7. Tell him that to be comfortable and relaxed, a pillow under his knees may help. Ask the patient to flex his knees and place a pillow under them. 8. Instruct the client to breath through mouth and take slow, deep breaths. 9. Before you start your examination, ask him if he has any painful or tender areas in his belly. Remember that those areas should always be assessed at the end of the exam. 10. Reassure the client that you will be slow and gentle and will warn him when you will examine these areas. Answers will vary.

MODULE 3 H3:5

ANSWER KEY

Oral Presentation: Hypertension

High Blood Pressure or

One of the most dangerous aspects of hypertension is that people may not know that they have it. There are generally no signs and symptoms of high blood pressure, so people usually don't feel it. It can easily lead to a stroke or heart disease, so it is usually called the silent killer. Fortunately, high blood pressure can be easily detected, and under the supervision of medical doctors it can be controlled. Research the medical condition of hypertension and present your findings to your peers and teacher. You may have to do it a lot at school or in front of your colleagues at work. It is important to plan and prepare well for a presentation. This will help you feel more confident and relaxed when you present. Here are some steps that you may follow while getting ready for this presentation. Put them in logical order. The first step has been identified for you. 3. Use pictures, posters or charts to make your speech more interesting. You can use PowerPoint pictures to help your presentation, but DO NOT put anything more than a few words on each slide and DO NOT use more than 4-5 slides for the whole presentation. Your goal is to engage your audience and make your presentation as interactive as you possibly can. 5. Make sure to get enough sleep on the night before the presentation and show up early to the place where you will present.

2. List one or two main ideas that address each item in the outline on a separate note card, using symbols and abbreviations to remind you of what you want to say. Number each card note so you know the order in which each idea should be presented. 1. Create an outline for your presentation. The following questions can help you organize your speech: What is hypertension? What causes hypertension? What are the symptoms of hypertension? Who is more likely to develop hypertension? How is hypertension diagnosed? What health problems are associated with hypertension? How is hypertension treated? 4. Rehearse the whole presentation many times before your due date. Try a mirror, a video camera or your friends. Try to look at your audience while you speak, and only glance quickly at the cards as a reminder. If you are doing it in front of your friends, ask them for feedback after your presentation.

Photo compliments of Microsoft clipart

Performance Criteria Analysis

ESL For Health Care Workers

Oral communication skills Health care workers know how to gather, interpret and relay information, when working with patients and as part of a team: Ask questions Use active listening skills Give oral presentations Show an appreciation of the appropriate use of formal and informal language (including idiomatic expressions), and jargon

Writing skills - Health care workers know how to write with accuracy, clarity and conciseness Take biographical details and write case histories

Describe symptoms Complete forms Compile medical reports: summarize, paraphrase and synthesize Use paragraphing, punctuation and layout effectively

Academic Foundation - Health care workers know the academic subject matter required for proficiency within their area. They use this knowledge as needed in their role. Convert common weights, measure, and volumes to metric as applied in the health care setting. PERFORM BASIC HEALTH CARE SKILLS Measure and record (graph) height, weight, and temperature, pulse and respiration (TPR), intake and output of body fluids. COMMUNICATION - Health care workers know the various methods of giving and obtaining information. They communicate effectively, both orally and in writing. Assess others' ability to understand Adapt communication to individual needs, including paraphrasing or translating Demonstrate ability to give and follow written and oral directions. Demonstrate examples of verbal and non-verbal communication