英语对话实验考试.docx

英语对话实验考试.docx

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英语对话实验考试

Dialoguebackground:

Johnsonisafortyyearolddaytwopost-oppatientwhohadanevacuationofasubduralhaematomaandopenreductioninternalfixationofherfracturedrighthumerus.Herinjuriesweresustainedafterbeingassaulted.ShehasahistoryofarightpartialmastectomyandisaType2diabetic/Niddm.Atpresentsheisapatientonaneurosurigicalward,calledFiveWest,andhasbeenlookedafterbyRNJohnforabouthalfanhour.

Dialogue1—Perfominggeneralobserations

Nurse：

Howareyoufeeling,Theresa?

Patient：

Ijustcan’tgetoverwhathashappenedtome.

N：

Well,that’stotallynaturalconsideringwhatyouhavebeenthrough…Athandoverthemorningnursesaidyoumightbeinterestedintalkingaboutwhat’shappenedtoyouwithoneofourhospitalcounsellors?

P：

Yes…I…uh…I’dliketodothat.

N：

Okthen,I’llarrangeforthesocialworkertocomeandvisityou.Nowifit’sokwithyou,Ineedtodoallyourobservationsandyourbloodsugar?

P：

Sure.

N：

I’lljustputthisthermometerintoyourear,itmightbeslightlyuncomfortablebutitwillonlytakeaboutoneortwoseconds（Nusesatympanicthermometer）…Thirtysevenpointfive,yourtemperatureisjustslightlyhigh.CanIhaveyourwristplease,sothatIcantakeyourpulse?

…Thanks.Yourheartrhythmisalittlefastandirregular.Doyouhaveahistoryofatrialfibrillationoranyotherkindofheartrhythmproblems?

P：

No,notthatIknowof.

N：

Youdon’tneedtoworryaboutit,therateis110whichisnotoverlyfast,butI’llsoonletthedoctorknowandseeifhewantsmetodoanelectrocardiographonyou.

P：

Alright.

N：

BeforeItakeyourbloodpressure,couldyoupleasetellmeifyouhavepreviouslyhadanysurgerydoneoneitheryourchestorarms?

P：

Yes…Oh！

Iforgottotellthedoctor,butI’vehadapartialmastectomyonmyrightbreast.

N：

Don’tworryit’snormaltohaveabitofmemorylossafteraheadinjury…Well,seeingthatyourrightarmisfracturedI’llneedtocheckyourBPontheleftsideinanycase.Pleaseextendyourarmout…WhenIinflatethebloodpressurecuffit’llbealittletight…It’s145/85whichisjustslightlyhigh.Doyouhaveanyhistoryofhighbloodpressureatall?

P：

No,noneatall.

N：

Doyoufeelanypaintatpresent?

P：

Bothmyheadandarmarejustalittlesore,butthepainkillersareworkingwell.

N：

Ok,wellthat’sgoodtohearTheresa…NowI’mgoingtocheckyouroxygenlevel,pleaseputoneofyourfingersintothisprobe（Ncountspatient’srespiratoryratewhilstwaitingfortheoxygensaturationreading）…Youroxygenlevelis86%,that’salittlebitlowerthannormal,doyoufeelshortofbreathatall?

P：

YesJohn,justalittlebitandIseemtobedevelopingabitofacough.Moreandmoreyellowphlegmiscomingup,see……（Pshowsthenurseafewusedtissuesthatareinherhand）.

N：

Yes,quiteabitthere.I’llcallthedoctortocomeandlistentoyourchestandinthemeantime,I’llturnupyouroxygenalittle.Oh,andhereisapaperbagyoucanusetodisposeofallyourtissues（Nsticksapaperbagonthepatient’sbedsidetrolley）.

P：

Thanks.

N：

Mypleasure.

Dialogue2—Performingneurovascular,bloodsugareandneurologicalobservations

P：

John,I’malittleworriedthatmyvitalsignsaren’tnormal,amIgoingtobeok?

N：

Icanreallyunderstandthatyoufeelanxiousaboutthings,butmostofyourobservationsareonlyslightlyoutofthenormalrange.Forsomeonewhohasexperiencedwhatyouhavetheselastfewdays,youarerecoveringquitewell.

P：

Good,that’sarelieftohear.

N：

Bytheway,ifyouarebrewinganykindofachestinfectionitisevenmoreimportanttodothosehalfhourlydeepbreathingandcoughingexercisesthatthephysiotaughtyouearlieron.Youalsoneedtodrinkmorewaterandtryandrelaxasmuchaspossible.Thesoonerwegetyousittingupinthechair,thebetterforyourlungstoo…There’scertainlyalotyoucandotocontrolyourownrecoveryandensurethatit’ssmoothaspossible.

P：

Ok,I’llmakesureIfollowyouradviceandIhavealreadybeenusingthatbreathingexercisethingwiththeplasticballsinit（incentivespirometrydevice）quiteoften.

N：

Verygood.NowIneedtodoyourcirculationobservations.I’lljusttakeaquicklookatyourfingers（Nstartstoperformneurovascularobservations.）…yourcirculationlooksfine.Canyoumoveyourfingersaroundplease?

…Good.Canyoufeelmetouchingthem?

P：

Yes.

N：

Doyoufeelanytinglingornumbnessatall?

P：

No,Idon’t.

N：

I’lljustdoyourbloodsugaragain…CouldIpleasehaveafingerfromyourlefthand?

…You’lljustfeelasmallprickonthefinger…Okyourbloodsugarisseven,that’sfine.

P：

Good.

N：

Ok,lastlyI’lljustdoyourneurologicalobservations.I’msureyouaresickofansweringthesequestions,butI’llneedtoaskthemagain,what’syourfullname?

P：

TheresaElizabethJohnson.

N：

Andcanyoutellmewhatdayoftheweekitis,whatdate,monthandyear?

P：

TodayisFriday,right?

N：

ActuallyitisMonday,butdon’tworry,itisnotunusualwhensomeonehascomeintohospital,especiallyafteraheadinjury,togetthedaysmixedup.

P：

Ok,butI’msureit’sMarch,somewherearoundthemiddleofthemonth,anditis2007.

N：

Yesspoton,indeeditisMarchthesixteenth2007.Canyounowpleasesqueezemyhandsashardasyoucanwithbothofyourhands?

（Ngesturesforwardwithtwofingersoneachhandstretchedout）…That’sgood…Nowstretchbotharmsoutstraightinfrontofyou,levelwithyourshoulders,pleaseholdthemupforfifteensecondsandcloseyoureyes…Good…Andjustpushyourfeetagainstmyhands…Ok,niceandstrong…Nowpleasebendyourkneesslightly.

P：

Likethis?

N：

Yeah,exactlylikethat.NowIwillpushdownandIwantyoutoresistmeashardasyoucan.Ok,onthecountofthere.One,two,there…Great,yourlimbsareallverystrong.

P：

Atlast,somegoodnews!

N：

Yes!

…Finally,Ijustwanttoshinethislittletorchintoyoureyes,itisquitebright…Yourpupilsareequalinsizeandreactingnormallytothelight.Overall,youaredoingverywellbutwemustworkingtogethertogetyourchestright.

P：

Right,canIsitinthechairassoonaspossible?

Dialogue3—Reportingobservationstoamedicalofficer

N：

Hello,FiveWest,Johnspeaking.

DR：

Hi,John,it’sTony,youpagedme、

N：

Yes.HiTony.IjustwantedtoupdateyouaboutacoupleofissuesrelatingtoTheresaJohnsoninbedfive.

DR：

Sure,goahead.

N：

I’vejustdoneallherobsandwhileherGCSisfineatfifteen&herrightarmisneurovascularlyintact,shewasdesaturatingtoeightysixpercentontwolitresofoxygenvianasalprongsandtachypnoeicatarateoftwentyeight.Sheonlyhasalowgradefeverofthirtysevenfive,butiscomplainingofanincreasinglyproductivecough.

DR：

Ok,haveyouturneduptheoxygen?

N：

Yes,sheisnowsaturatingatninetypercentonfourlitresofoxygenvianasalprongs.Inadditiontothisherheartrateisonehundredandtenandisquiteirregular.ShedeniesanyhistoryofarrhythmiasandinherbaselineECGshewasinsinusrhythmatarateofseventy.Sheismildlyhypertensiveatonehundredandfortyfiveoneightyfive,butsaysherpainisfairlywellcontrolled.

DR：

Well,herchestx-raywasclearonadmissiontoED（EmergencyDepartment）butitsoundslikeshemaybebrewingachestinfection.I’llbeuptheretoreviewherchestandthoseotherissuesinaboutfiveminutes.Couldyoupleasegetasputumspecimenoffher,anddoa12leadECG.Canyoualsocallforamobilex-ray;Ishouldbetheretogivethemtherequestformbeforetheyarrive.

N：

Noproblem,howaboutIputaHudsonmaskonhertoo?

DR：

Yes,good,pleasetitratetheoxygenflowtomaintainherO2satsabove95%.

N：

Willdo,seeyousoonthen.

DR：

Ok,thanks.

Dialoguebackground:

Anneisafiftyyearoldwomanwhohasbeenadmittedtotherespiratoryward,ThreeSouth,foraninfectiveexacerbationofherchronicobstructivepulmonarydiseas（COPD）.Shehasbeenaheavysmokerofbothcigarettesandmarijuanaforapproximatelythirtyyearsandhasnotbeenabletocutdownatall.Hermedicalhistoryalsoincludesmultiplesclerosis,mildchronicrenalfailure,deepveinthrombosis,depressionandbeingonlongtermprednisoneforherCOPD.Sheopenlyidentifiesasbeinggayandisoftenvisitedbyherpartner,Sharon.Atpresentshebecomesshrtofbreathattheslightestlevelofexertionandisveryweak,listlessanddepressed;sheisdependentonlowflowoxygenandintermittentBIPAP.RNJulieadmittedAnneeyesterdayandhasbeenallocatedtocareforheragaintoday.

Dialogue4—Assistingapatientwitheatinganddrinking

N：

Anne,hereisyourdinner.

P：

Idon’tfeellikeeating.

N：

Doyoufeelsickoruncomfortableinanyway?

P：

No,Idon’tfeelsick,butIhatethefoodandjustfeelsoshortofbreathandweak.Ijustdon’thaveanyappetiteatall.

N：

Icanreallyunderstandthatyoudon’tfeeltoohungrywithallyourdiscomfortatpresent,butyourbodyneedsthenutritionsothatyoucanregainyourstrengthandenergy.Perhapsyoucouldjusttrytoeatasmallamount?

…Pleaseletusknowifthereissomethingyouparticularlyfeellikeeating.

P：

No,therereallyisn’tanythingatallthatIfeellikeeating…ugh…Ok,I’lltryandeatalittlebit.

R：

I’llcutthemeatintosmallerpiecesandopenthingsupforyou.

P：

Thanks.

N：

Mypleasure…Willyoubeokfeedingyourself?

P：

Yes,Ithinkso…（Peatssomeofhermeal）

N：

Areyoufinishedyourmealorwouldyoulikesomemoretime?

P：

Finished!

Nomoreplease!

N：

I’lltakeyourtrayawaythen,ok?

（Pnods）…Icouldseethatwashardworkforyou,butyoudidreallywell,youatehalfofthemeal!

…WhattimewillSharoncomeintoday?

P：

Itshouldbeprettysoon;assoonasshehastakenthedogsforawalk.

N：

Whatkindofdogs