Lesson four
(Part one)
Unit three
Instructions and procedure
Introduction:
* In training environment ,doctors , nurses and other health 
professionals need to be able to give and receive instructions
about how to perform a wind range of a procedure.
*However, working in hospitals as newly qualified /junior 
doctors or nurses ,you will be under supervision of senior
doctors , nurses or professional people.
*perhaps you will be assigned to come with senior doctors 
to go on ward round , take some patients case history ,
writing up notes ,obtain consent to carry out the procedure
for the patient . Sometimes they may ask the junior doctor
or nurses to advice treatment or do some investigation.
* In such setting , It’s possible to be very direct and use the 
impetrative form of the verb the needle : Insert the needle
;wear the sterile gloves ;wash your hand , …..etc .This can be
varied by adding the word you insert the needle …The
imperative doesn’t sound impolite here , as each command
forms a step which is part of an accepted the instruction
like a formula.

Patient care (p.21-1)
consent
Introduce your self
It’s legal requirement of the patient on •
particular treatment
or procedure.The consent may be necessary •
in writing .The patient has the right to know
all risks ,benefits , and treatment before you
undergo to any kind of procedure .The
patient has the right to accept or refuse.
It’s very important to the patient to put the •
patient at ease..The doctor may be wearing the
name badge but the patient may not be wearing
not be able his or her glasses .the patient may
to read . E.g. Good afternoon ,Mrs….My name
is……… and I am ………………..
Prepare the
trolley
All the necessary equipment need to be •
present . A missing instrument in the middle
of the procedure may cause problems.
What else you need to do
before any procedure
p.21 - 2
1-Explain the procedure to the patient 
simply and clearly
2-Explain why it’s necessary. 
3-what the procedure will be like for the 
patient
4-think about previous successful procedure
you have done.
5-prepare the procedure by thinking through
each step and use the process to check the
equipment .
6-Decide whether you need and assistant .

Vocabulary : P.21-1
Lumbar puncture (LP)
Definition: Lumbar puncture, they remove a 
sample of CSF –cerebrospinal fluid from the
spine .In which the needle is inserted to
collect a sample of fluid for testing to
send it to laboratory. 
*what does the LP show ? 
 Infection of membrane surrounding the 
brain and the spinal cord.
 show the bleeding ,stroke 
Meningitis 
 tumors (cancers) 
Explaining the lumbar puncture
procedure:
First ,you prepare the equipment on the trolley. 
Second, you should wash your hand thoroughly
and put the sterile gloves . Next ,you will ask the
patient to lie on with knees drawn to his chest
.Then you sterilize the area of the patient back
and inject the local anesthetic to numb the area
.After that ,you mark the patient between L3/4
where the needle to be inserted . Once the
needle has pierced the Dura mater ,you withdraw
the stylet. After this, you attach the manometer to
measure the pressure of the fluid. After you finish
measuring it , you drain 10 drops of CSF into
three specimen tubes .Finally ,you withdraw the
needle while placing the pressure on the puncture
site.
Language Spot
Giving instruction: 
- The imperative form of the verb can be used 
for giving clear and direct instructions.
positive
negative
-wash your hand
-get out of bed
-complete the note
-listen
-put a plaster over
the wound
-Wear protective
clothes
-Don’t throw
used items on the
floor
-Don’t give the
patient any fluid
-Don’t complete
the note
Use always and never with the imperative
to make instruction stronger
E.g. Always wash your hand 
Always obtain consent from the atient 
before any procedure.
Always throw the used items in the 
trash bin .
Never take any drug before medical 
procedure.
It’s common to use (Remember to +infinitive
/Don’t forget to +infinitive)to give instruction.
E.g. . 
- remember to take your medicine 
-don’t forget to come at 7.00 a.m 
-remember to inform your family 
-Don’t forget to take your medication on
time.

Explaining procedure:
-when you come to explain procedure ,we 
put “ you “ before the imperative.
e.g.
you Wash your hand and put on your gloves
. you
apply pressure to the wound.
Note: while explaining procedure you need to
use some words like: first ,second, next , then,
before , after that , finally …..etc.
How to control external bleeding
First , you should apply 
pressure to wound
.Second ,clean the wound
with antiseptic .Next,
when the bleeding is
controlled , secure the
dressing with a bandage
.Finally , after the dressing
is in place , don’t remove
it to check the wound.

Adverbs :
- adverb is necessary in order to describe
how action is done (-ly)
E.g. - Examine the patient carefully 
- you clean the area thoroughly 
- advance the catheter gently 
-insert the needle slowly 

IM injection ( Intramuscular injection)
Purpose : to insert a 
certain
drug in to the muscles . 
Description : 
-upper arm 
-upper leg (thigh) 
- hip (buttocks) 
Instructions for this procedure:
1-first , ensure you have identified the patient and assist 
them into a position which is comfortable .
2-clean the site with alcohol swab 
3-prepare the syringe by removing the needle cover, 
inverting the syringe and expelling any air.
4-spread the skin with your finger and inject the needle. 
5-pull back the plunger a little .If you see blood enter the 
syringe ,pull the needle out and inject the medication, if you
don’t see any blood simply inject.
6-pull the needle or withdraw it and dispose it in the sharp 
containers .
7-use the gauze to dab any blood ,cover it with a bandage. 
8-wash your hand. 
Speaking : p22-1
Wet hands and forearms
under running water
Take soap from dispenser
Soap up ,rubbing palm to
palm
Rub with finger interlaced
Massage between fingers
,right palm over back of left
hand ,left palm over back of
the right hand
Rub with finger locked
,including finger tips
Rub rotationally with
thumbs interlocked
Rinse thoroughly
Dry hand thoroughly
Dispose of towel into foot
operated pedal bin.Don’t
re contaminated hands by
touching the bin lid.
The end