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Wounds, Charts and Medication:
Tips on teaching nurses
Virginia Allum
Introducing ..Virginia Allum
• Co-author with Patricia McGarr of ‘Cambridge
English for Nursing’ (Int Plus and Pre-Int)
• Currently Staff Nurse in a private hospital (mix of
private and NHS patients)
• Productive Ward Project Leader and Infection
Control Link Nurse
Our session today
• We’ll look at Wounds (an example of a nursing
procedure ) / you’ll do some medical terminology
activities
• We’ll look at Charts (example of common writing skills
needed by nurses) / you’ll complete a Wound Chart
• We’ll look at Medication (use of maths terms and
abbreviations) / you do a Find-a-Word
Before we start ,
Why teach Specialist English for Nurses?
Nurses leave NHS for better life abroad
Daily Mail 7 Nov,2010
‘An increasing number of overseas nurses are
already arriving in Britain to fill the rising number
of hospital vacancies.
Last year Britain imported 8,500 nurses and
midwives - many coming from poor countries
such as India, Pakistan and the Philippines.’
What do stakeholders demand of
overseas nurses?
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Ability to communicate effectively
Safe practice
High standards of technical knowledge
Cultural sensitivity and awareness
Good teamwork
Ability to work with other Health Care Professionals
www.nursepostcard.com
Here to Stay? International Nurses in
the UK 2003 (NMC)
Four main areas of concern for hospital managers
who employ overseas nurses
1. language
2. differences in clinical and technical skills
3. racism in the workplace
4. reaction of patients.
Language areas of need
• Everyday communication
• Nurse-to-nurse communication
• Technical knowledge (medical
terminology)
http://www.nursingtimes.net/pictures/182xAny/7/2/1/1205721_1205409_
nurse_talking_paperwork.jpg
Let’s look at wounds...
• Or any nursing procedure
• Specialised language (look at wound websites,
prefixes + suffixes) (R, S, L, W)
• Recycle general English (asking for info, giving
advice, assessing pain, giving directions)
• Maths terms e.g dimensions of wound, amount of
discharge
• Opportunity for role plays
A word about role plays
• They are serious enough for ESP
• Perfect opportunity to use specialised
language in authentic situations (lots of
handovers, telephone referrals in nursing)
• Ss can write them and own them
• Bring in guest speakers (e.g real nurses or
student nurses ) to confirm authenticity
Wounds: opportunity to look at...
• Verbal descriptions e.g. in handover
• Written descriptions e.g. Wound Chart
• Abbreviations
• Equipment e.g Dressings
• Documentation: Care pathways
• Staff in specialty areas: Infection Control
Nurse, Tissue Viability Nurse
What is there to say about wounds?
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Types of wounds (surgical, ulcers, lacerations
Position on body (on the right ankle)
Description ( order of adjectives)
Colour (of the surrounding skin, wound
discharge)
• Size (width and depth)
• Amount of exudate (small, moderate, copious)
What else?
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Presence of drains
Equipment used (VAC)
Dressings ,surgical tape, bandages
Sutures, clips, staples and Steristrips
Nursing jargon v medical term (healing
v granulating )
Types of wounds
• Vocab : use Pharmaceutical company websites
e.g. http://int.hansaplast.com/medinfo/wound-care-beautiful-healing/types-ofwounds.html
• Use pictures or diagrams ; match terms
e.g. Match medical term to everyday term e.g
contusion = bruise
• Use nurse education on Pharmaceutical sites e.g.
T.I.M.E on Smith & Nephew
Warning: Pictures of wounds on next
slide
• Use authentic photos of wounds if
possible
• Be advised that some are pretty awful!
• Next slide : not too bad but..
1
1
3
2
4
Now, in pairs, do handout exercise 1.
Photo
number
1
2
3
4
Type of wound
a) Pressure Ulcer
b)Surgical wound
c) Cut or laceration
d) Bruise or contusion
Describing a pressure wound
What can you get out of it for a lesson?
• Use body diagram (front and back) –see WSheet
• Practice of body parts (everyday v medical term)
• Practice of ‘ Where is the wound? (Position of the
wound)- The wound is over the right lateral malleolus
(ankle)’
• Exercise: Blank diagrams of the body with numbered
wounds. In pairs, Where is wound (!)?
Body Diagrams
• Terminology (body position – anterior,
posterior etc) – on the back of..
• Parts of the body e.g where pressure
ulcers may occur - on her sacrum
• Everyday terms versus medical
terminology - shoulder blade – scapula
Now, in pairs, do Exercise 2
• Look at the numbered diagrams of the body
• Complete the table using terms in the box below
• Further activities: make up double-side cards
(everyday term one side, medical term reverse
side) – pr work.
• Speed work, 2 groups , complete table on WB .
First team to get rid of cards, wins
Humerus
Outside ankle bone
back of the head
Number
Everyday term
1
Heel
calcaneus
inside ankle bone
Thigh bone
Medical terminology
(Heels)
2
Lateral Malleolus (Malleoli)
3
Medial Malleolus (Malleoli)
4
Greater Trochanter (s)
5
Sacrum
6
Ischial Tuberosity (Tuberosities)
7
vertebrae
8
Occiput
9
Ears
10
Shoulders
11
Scapula (Scapulae)
12
Elbow (Elbows)
13
Iliac Crest
Humerus Outside ankle bone
back of the head
calcaneus
inside ankle
Humerus
back of the
head
calcaneus
inside
ankle bone
Thigh bone
boneOutside ankle bone Thigh
bone
pinna
shoulder blade
hip bone lower back
Olecranon process
spine
flank
Matching cards - example
Haemat-
-oma
erythr-
Ven-
Necro-
-itis
Ser-
Esch-
scab
red
blood
Swelling
plasma
dead
Inflammation of
Vein
Using websites for inspiration
• http://news.bbc.co.uk/1/hi/health/1751163.stm
'Living bandages'
for wounds The
technology for the
'bandage' was adapted
from drinks cartons
Online: BBC Radio Transcripts
http://www.bbc.co.uk/radio4/science/casenotes_tr_
20050208.shtml
RADIO SCIENCE UNIT
CASE NOTES 9. - Wound
Healing
Use clips on websites: Wounds UK
http://www.wounds-uk.com/
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Use demonstration videos as Listening Practice.
Prepare worksheets (missing terms)
Vocab matching
Ss design a teaching session e.g. How to set up a
negative pressure wound treatment / in prs teach
each other
Charts and Documents
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Legal documents
Completed each shift
Used as communication between shifts
Nursing Care Plans
Integrated Care Pathways (Wound Charts)
Policies and Procedures
What are Nursing Care Plans?
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=32
• Use the online resource to create a printable Care
Plan
• Use as vocab resource
• Use as ‘Handover Resource’ – S (nurse) gives
information about wound care during handover
e.g I’ve encouraged increase intake of proteinrich foods to help healing.
Integrated Care Pathways
Wound Chart
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ICPs require nurse to tick correct box
Reading > Writing
Specific terms used
Assessment often uses grading system
(Grade 1: not too bad → Grade 5 : very
serious
Wound Chart on p2 of worksheet
• Vocab work – prefixes and suffixes flashcards
• Description of wounds – recycle descriptive
language, order of adjs
• Grade of pressure ulcer – match photos
• Wound drainage (discharge) –jargonpurulent discharge = pus, discharge = ooze
Example of wound chart
Now, Exercise 3: Where is the wound?
• Complete the Wound Chart using
information in the scenario
WOUND CHART
NAME: Mrs A. Patient
WOUND TYPE
TICK
Abrasion
Haematoma
Laceration
Ulcer
Surgical incision
DOB: 30/ 11/ 1924
WOUND
Tick Wound
Tick
APPEARANCE
Drainage
Blister
Purulent
(pus)
Erythema
Haemoserous
(Redness)
(Blood-stained
fluid)
Inflammation
Nil
Maceration
(over-moist)
Slough
Eschar
(black, hard scab)
Epithelialisation
(healing tissue)
Pain
Tick
Site
Dressing
change
continuous
intermittent
When limb
elevated
Nil
Mrs Anna Patient has a 3 cm long laceration on her left forearm caused
by a dog bite. The skin around the wound is red and inflamed . There is
a moderate amount of greenish pus in the wound caused by an infection
which is being treated with oral antibiotics. The wound dressing is
being changed every two days at the Outpatient Clinic. The patient
reports a small amount of pain when the dressing is changed. She takes
a painkiller before the dressing change.
The Wound Chart ex can be ..
• A practice of handovers (write a dialogue using
given info / complete missing terms in
dialogue/ practise as a role play )
• Used for different scenarios (dog bite, fall ,
burn, operation)
• Used to recycle language ( She’s got a .. , The
ulcer’s on her sacrum...)
• A practice of vocab of body parts / areas
Scenarios..here is another
• Mr D Hatworth was repairing his fence when he
accidentally dropped a piece of wood which
grazed his right lower leg. He left the wound
untreated for two weeks apart from dabbing on a
bit of antiseptic cream. Now, the wound is painful
to touch and is red and inflamed. There is a small
amount of blood-stained discharge
Answers – students complete wound
chart
• Wound: abrasion
• Wound Appearance: erythema,
inflammation
• Wound Drainage: Haemoserous
• Pain: Site
Also, wound charts are a chance to..
• Do vocab exercises e.g prefix and suffixes e.g necro-,
-osis, haemat- , -oma, erythro- , ven-,
• Make matching cards / flashcards
• Practise communication skills e.g Advise patient on
after care of wound dressing - It’s important to keep the
dressing dry, You’ll have to come back next week for a new
dressing → make an appointment / make a phone
call to confirm appointment with patient
Wound Chart language
• Wound Type – ‘It’s a ..’
• Wound Appearance - ‘ It’s got.. , It’s got an
area of..’
• Wound Drainage – ‘There’s a small amount of..’
• Pain - ‘ Is it painful? , Do you have any pain?’
When is the wound painful?
Medications – important area!
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Safe and accurate practice is essential
Legal and patient health implications
Oral medications (tablets, liquids)
Nebulizers and inhalers
Injections: IMI ,IVI,
IV fluids
PR medications (suppositories, enemas)
Oxygen
Language skills needed
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Abbreviations (R, W, L and S) e.g bd, tds
Maths terms e.g. Morphine 15mg – pronun. practice
Measurement terms e.g ml, mcg, 80, mg/ml, units
Medication use: e.g Read entries in BNF or MIMS e.g
side effects
• Check for interactions with other drugs e.g (R)
literature on drug in blurb or on internet
• Handover information e.g (S) intolerance to pain killer
Medications : opportunities for?
• Research practice – journals, EBP online
• Writing practice e.g develop a Public Health
Poster on Hypertension drugs → present to
class (speaking practice)
• Reading and comprehension practice –e.g.
Compare drugs used for diabetes- small
group work, present to class → teamwork
Medication : language practice
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Abbreviations e.g sc, prn
Terms e.g nocte, mane
Instructions e.g. Take this medication after food
Polite advice e.g It would be a good idea to..
Warnings e.g you must keep the medication in
the fridge
The Medication Chart
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Understand terms used in the chart
Get a copy of a medication chart for practice
Latin terms
Maths terms
Use flashcards, cross-words, Find-a-Word to
practise terms
Drug Chart - example
Allergies
Adverse Drug
Reactions
BD
QDS
TDS
Anticoagulants
Slow
Release
Ex 4: Medication Table
• Read through the terms in the medication table
• Ask your ‘teacher’ if you don’t understand any terms
• Now, take turns to find a term explain the meaning
to your partner
• Hint: break into chunks or students will not survive
this exercise!
Medical terms for
medications
a.c
amps.
b.d (or b.i.d)
Inh.
IM or IMI
IV or IVI
IV Fluids
mane
Neb.
Needle gauge
Meaning
NI
nocte
OD or daily
oral
p.c
per NG
pr
prn
q.i.d or qds
R
s.c
s.l
stat (statim)
t.d.s
top.
units
Venflon
W
Nurse Initiated medication e.g. Paracetamol, Coloxyl with Senna.
At night
Once a day
By mouth
After meals
through the nasogastric tube (through nose into the stomach)
Per rectum e.g. a suppository
whenever needed ( for pain, indigestion, constipation)
Four times a day (quad= 4) .Doesn’t have to be in 6 hour intervals.
Refused by the pt. (written on the medication chart)
Subcutaneous ie an injection given into the subcutaneous layer of skin
Sublingual or under the tongue
immediately e.g. a stat dose of insulin
Three times a day (Ter in diem)
Topical ie a cream or ointment e.g antibiotic cream
Insulin is prescribed in units. E.g. 24 units of Insulotard
Type of intravenous cannula. Abbrev to IVC .
Withheld (written on the medication chart) e.g. Digoxin because the pulse was 58.
1/24
2/24
4/24
6/24
or 10
or 20
or 40
or 60
Before meals
Ampoules . This is the container for liquid medication for injection.
Twice a day (bi= two)
Inhaler e.g Salbutamol inhaler
Intramuscular ie an injection given into a muscle
Intravenous ie an injection given into a vein
Fluids given through an IV cannula. Also called a ‘drip’
In the morning
Nebulizer e.g Salbutamol nebulizer
Size of the needles eg 19g (drawing up needle) 21g (IM injections ) 23g (fine for sc injections)
Hourly or every hour
Second hourly or every two hours
Fourth hourly e.g. 4/24 T P R (Note: this is 6 times a day)
Every six hours (Note: this is 4 times a day)
Medication Find-a-word
• In pairs, find a word relating to medication
administration in the Find-a-Word
• Tell your partner what it means
• Use previous glossary to help you
In pairs, identify a term in the Find-a-Word below using the table above. Explain the meaning of the term to your partner.
A
N
M
P
F
O
E
R
O
R
O
A
U
L
O
D
E
C
B
S
T
U
M
T
B
A
E
L
N
I
E
N
H
L
U
I
E
N
N
I
J
G
T
E
U
S
C
N
T
I
Q
E
N
D
I
S
A
R
B
O
V
S
C
T
A
E
I
O
T
O
N
P
F
L
L
A
I
C
Good medication calculation sites for
nurses – lots of related terms
• Medication Terms
• http://home.sc.rr.com/nurdosagecal/Conversions.
htm
• http://www.jcu.edu.au/cgi-bin/nursing/test.cgi (if
you have problems go to www.jcu.edu.au and
Search: Nursing Calculations Practice
Other medication activities
• Reading a Medication chart – use scenario
• The IV Prescription Chart
• The 5 Rights of Drug Administration – research and
make an educational poster
• Practice of role plays for medication administration /
recycle questions / asking for information ‘Do you
need something for pain?’ / giving advice ‘ It’s best
to take this tablet with food’
Tips : Use websites
• http://www.bhf.org.uk/living_with_a_hear
t_condition/treatment/medicines_for_the_
heart.aspx
• http://www.proprofs.com/flashcards/story
.php?title=types-wounds
Invite guest speakers
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Nursing lecturers
Nursing students
Nurses
Ask them to show authentic charts and
documentation (make sure any identifying
information is obscured first) e.g hospital
logo
Any questions?
Thank you for having me
PS: answers to the exercises are on my blog
http://englishfornursingandhealth.blogspot.com/