Read the text and do the exercises that follow.

THE WORK OF THE IN-PATIENT DEPARTMENT

Patients whose state is too serious are admitted to hospital. They are usually directed to hospital by the district doctor. Emergencies are hospitalized even without any doctor’s recommendation. There are general hospitals where patients with different diseases are treated. There are teaching and research hospitals where students are taught and research work is done. There are also special hospitals, such as infection, children’s, military hospitals, etc.

A person who is to go to hospital is first admitted to the reception ward. On admission the patient’s history is taken as part of clinical case-taking. Apart from the patient’s personal data (name, surname, address, age, place of employment, occupation, etc), the case history should contain the date of admission and discharge, complete physical examination and laboratory studies, the systemic classification of the common symptoms and signs, the diagnosis made by the doctor in charge as well as clinical notes. They include the description of the course of the disease with any changes in the symptoms and the condition of the patient, the medicines administered and the effect of the treatment. All these findings will compose the history of the present illness.

As soon as the patient is admitted to the in-patient department the ward doctor fills in the patient’s case history. It must include the information about the patient’s parents – if they are living or not. If they died, the doctor must know at what age and of what causes they died. The doctor must know if any of the family has ever been ill with tuberculosis or has had any mental or emotional impairment. This information composes the family history.

The patient’s medical history must include the information about the diseases the patient has suffered, about the operations he has undergone, about any traumas he has had. The patient’s blood group and his sensitivity to antibiotics must be determined and written down in the patient’s case history. These findings compose the past history.

The hospital staff carry on the following duties. Doctors make their morning rounds, write case reports and give instruction to the nurse as to the treatment of the patients. Surgeons perform operations and dress wounds. Nurses carry on the doctors’ orders, give out drugs, take the patients’ temperature, feel their pulse and give them injections. Laboratory assistants collect blood and throat cultures from the patients, make blood counts, urine and other kinds of analyses.

Working days at the in-patient department are very busy. Sometimes cases are complicated.

Here are some cases admitted to the in-patient department.

The onset of patient Hill’s disease was sudden. On admission his condition was poor. The doctor in charge examined him thoroughly. He questioned the patient and found out that severe pain in the heart and substernal area had begun two days before. He was still complaining of the pain radiating to the left arm and shoulder. The patient was pale, and his lips were cyanotic. He suffered from breathlessness. The pain and breathlessness increased on the slightest physical exertion. The doctor determined that the borders of his heart were dilated, the heart sounds were dull, the pulse was irregular at times. He also examined his other inner organs and found out that it was necessary to take the electrocardiogram, to make the analyses of blood and urine. Having got all the subjective and objective findings the doctor made the initial diagnosis of angina pectoris which was confirmed later.

Emergency admission to hospital was arranged at night. The patient was a retired bus driver, 65 years of age, having a severe chest infection. He couldn’t walk and was brought to the ward on a stretcher. On arrival in the ward, he was unable to give any history. His wife stated that a week before an upper respiratory tract infection accompanied by cough and general malaise was diagnosed by the general practitioner. But two days later the general practitioner returned and found the patient very excited and breathless at rest. The doctor insisted on hospitalization. Immediate examination was carried out, urine and blood analysis were made, and the patient’s chest was X-rayed.

Another patient was a 39-year-old male who had been confined to bed for several days. The pain in the chest hadn’t subsided by the time he was admitted to hospital. He was admitted to hospital with acute myocardial infarction. On his admission to hospital, the blood pressure measured 120/80. Normal pulsations were found in the radial, ulnar, and carotid arteries and in the abdominal aorta, but pulses in both legs were reduced to one half of their normal amplitude or less. The feet were warm with a normal colour and no swelling was evident. An electrocardiogram showed typical changes of infarction. Work at the in-patient department requires deep knowledge of medicine, quick thinking and a great sense of responsibility. A good bedside manner is of great importance. There is no doubt that such an attitude to the patients helps much in their recovery.

I. Practice the pronunciation of the following words and word combinations.

therapy - to have practical work in Therapy, to get a credit in Therapy, to take the exam in Therapy, therapeutic [ˌθerə'pju:tik], at the therapeutic department, at the in-patient therapeutic department

a ward - a nurse on duty is in the ward, the reception ward, she works at the reception ward, a ward doctor, he works as a ward

heart attack - the onset of the heart attack, a bad heart attack, he has a heart attack

impairment - heart impairment, impairment of blood supply, impairment of health, impairment of blood pressure

procedure - to carry out some procedures, the nurse carried out some procedures

percussion - by means of percussion, percussion of the chest, percussion of the heart area

auscultation [ˌo:skəl'teiʃn] - the method of auscultation, by means of auscultation, auscultation is applied while examining a patient

a doctor in charge - to work as a doctor in charge, he is the doctor in charge of this ward 

to radiate - to radiate to smth, the pain radiates to the shoulder, the pain radiates to the back, the pain radiates to the side

cyanotic [ˌsaiə'notik] - cyanotic lips, cyanotic hand, the patient was cyanotic, to look cyanotic

breathlessness - a bad breathlessness, to suffer from breathlessness, to relieve breathlessness, breathlessness subsides completely

to dilate - to be dilated, the borders of the heart are dilated, the stomach is dilated

urine ['juəri:n] - the analysis of urine, urinalysis [ˌjuəri'nælisis], to make the analysis of urine, to make urinalysis to confirm

to subside - subsided, the pain subsides, breathlessness subsided gradually, fever will subside completely

to discharge - to discharge a patient from hospital, to be discharged from hospital

II. Discuss the following questions in pairs:

1. When are patients admitted to hospital?

2. What cases do general hospitals deal with?

3. What kinds of hospitals are there?

4. What data are recorded in the patient’s case history?

5. What are the responsibilities of the doctor on duty at the reception ward?

6. What information does the history of the present illness include?

7. What data compose the family history?

8. What findings does the past history contain?

9. What are the duties of the hospital staff (doctors in charge, nurses, and laboratory assistants)?

10. Describe the condition of the first patient admitted to the in-patient department.

11. Who examined this patient?

12. What was revealed on examination?

13. What analysis was it necessary to make?

14. What diagnosis was made?

15. What treatment was administered?

16. What preceded the retired bus driver’s admission to hospital?

17. What was his condition on admission?

18. What examination was carried out?

19. What diagnosis was the 39-year-old male patient admitted to hospital with?

20. What findings were revealed on his admission?

21. Was the diagnosis confirmed?

22. What is important to know dealing with in-patients?

III. Find English equivalents for the following word combinations or sentences:

1. инфекционная больница; 2. хороший подход (врача) к больным;
3. страдать от одышки; 4. инфекция верхних дыхательных путей; 5. было необходимо снять электрокардиограмму; 6. утренний обход; 7. сонная артерия; 8. пульс временами был неправильным; 9. место работы; 10. губы у него были синюшные; 11. настоять на госпитализации; 12. тоны сердца были глухие; 13. явный отек; 14. границы сердца были расширены;
15. описание течения болезни; 16. прикован к постели; 17. психические нарушения; 18. сильная боль, отдающая в левую руку и плечо; 19. дата поступления (в больницу); 20. группа крови; 21. чувствительность к антибиотикам; 22. боль и одышка усиливались при малейшем физическом напряжении; 23. инфаркт миокарда; 24. приемный покой; 25. чувство ответственности; 26. полное физикальное обследование; 27. предписания врача; 28. персонал больницы; 29. перевязывать раны; 30. лечащий врач.

IV. Translate the following sentences into English:

1. Лечащий врач — опытный терапевт. Он очень хорошо умеет обращаться с больными.

2. Тяжелые сердечные заболевания могут быть вызваны нарушением кровообращения.

3. Больная была прикована к постели. Даже малейшее физическое напряжение вызывало приступ острой боли.

4. Больные со стенокардией при физическом напряжении чувствуют боль, особенно при ходьбе на улице.

5. Наиболее тяжелые приступы стенокардии бывают (occur) ночью; как правило, больной просыпается от болей, при этом он чувствует необходимость сесть.

6. Лечащий врач прописал больному, страдающему тяжелым заболеванием сердца, уколы гепарина. Больной должен был соблюдать строгий постельный режим.

7. Чем больна ваша дочь? — У нее что-то с сердцем.

8. Данные анализов, сделанных в клинике, подтвердили первоначальный диагноз участкового врача.

9. Этот больной поступил в стационар после тяжелого сердечного приступа.

10. Bрачи делают все возможное, чтобы бороться с сердечно-сосудистыми заболеваниями.

11. С четверга он прикован к постели после тяжелого сердечного приступа. 12. При выстукивании определяются границы сердца, легких и других внутренних органов.

13. Синюшный больной был доставлен в приемный покой на носилках.

14. При помощи пальпации исследуются некоторые внутренние органы.

15.Говорят, что приступ стенокардии начался внезапно.

16. Нужно всегда соблюдать курс лечения, прописанный врачом.

17. Оказалось, что это лекарство произвело заметное воздействие на больного.

18. Нужно снять электрокардиограмму больному к трем часам.

19. Этого больного думают выписать из больницы через неделю.

20. Предполагают, что нарушение сердечной деятельности было вызвано передозировкой лекарствa.

21. Нужно всегда подробно и внимательно записывать все данные в отношении состояния больного.