医学英语第九讲.ppt

范文阅读ModelEssayReading,观察点PointsofObservation,UseofwordsStructureImplicationConnection,Example1(注意句与句之间连接),NosocomialInfectionMedical,surgical,andneonatalcriticalcareareasprovideaconcentrationofpatientsathighriskfordevelopingnosocomialinfection.Thisisareflectionofpatientsunderlyingdisease,thefrequentuseofinvasivemonitoring,andalterationofnormalflorabyantibiotics.,Oftenpatientsareincloseproximitytoeachother,promotingtransmissionbybusymedicalpersonnelwhofailtowashtheirhandsbetweencontacts.Cross-infectionhasbeenreportedtobeparticularlycommonamongthermallyinjuredpatients.,Furthermore,thewidespreaduseoftopicalantibioticsmayselectforcolonizationandinfectionwithmultiplyresistantorganisms.,Properdesignofcriticalcareunitswithregardtoseparationofpatientsbypartitionsandplacementofsinksattheentrancewaytoindividualcubicles,aswellasoptimalnursing-to-patientratios,mayberequiredtominimizetherisksofcrossinfection.,Otherssuggestedinfectioncontrolmeansinclude1)thenotificationoftheinfectioncontrolteambytheunitofallnewproceduresorproducts,and2)useofaclinicalflowsheetlistingallcatheters,datesofinsertion,andrationaleforcontinueduse.,Example2,NutritionandSurgeryPrepoperativeevaluationofthecardiovascular,pulmonary,hepatic,andrenalfunctions,togetherwithanassessmentoftheimmunologicstatusandphysiologicage,isperformedroutinelyinthepreparationofapatientforoperationinordertominimizeoperativeandpostoperativerisks.,However,anequallycriticalthoughsometimesdisregarded,factoraffectingsurgicaljudgmentisthenutritionalconditionofthepatient.,Nutritionalstatusisveryimportantinsurgerybecausecertainformsofmalnutritionincreasethemorbidityandmortalityofoperations;becauseparticulartypesofsurgicalproceduresnecessitateperiodsofrelativeorcompletestarvationpreoperativeand/orpostoperatively;andbecausespecificpathologicconditionsorlesionsthathavecausedorcontributedtothestateofmalnutritionoftenrequireoperativetherapy.,Moreover,accidentalorsurgicaltraumaprecipitatesthecatabolicresponsedescribedbyCuthbertsonandhisassociatesin1935,promotingexcessivenitrogenlossesandaccentuatinganyexistingproteindeficits.,Certainspecificnutritionalproblemsthatoccurlessfrequentlyinotherdisciplinesofmedicineoftenconfrontthesurgeon.,Theremaybeprolongedperiodsoftimeduringwhichpatientscannotbefedbymouthorbyintestinaltubebecauseofbowelobstruction,primarilygastrointestinaldisease,peritonitis,orotheralimentarytractconditions.Suchpatientsusuallyrequireparenteralmeansofnourishment.,Example3,ClinicalApproachtoNeurologicalDisordersPatientwithsymptomsandsignsreferabletothenervoussystemplacespecialrequirementsonthephysiciansclinicalapproach.,Themostimmediatetaskistoconsiderwhetherthesymptomsaremerelythenonspecificsignalsofasystemicdisorderorreflectsintrinsicneurologicaldisease.,Pain,headache,nausea,dizziness,fatigue,andweaknessalllackspecificityuntiltakenintocontextwiththerestofthehistoryandphysicalfindings;asoftenasnot,suchsymptomscanreflecttheemotionalravagesofdisturbedpsychologicaladjustment.,Tounderstandandtreathumanbeingsrequiresthatthedoctorknowwhoissickasmuchasormoreoftenthanwhatissick.PutinPeabodyswords:”Thesecretofthecareofthepatientiscaringforthepatient.”,Asecondconsiderationistorealizethatalthoughallpatientsaretosomedegreefrightenedofillness,concernoverthepossibilityofparalysis,severepain,ormentalimpairmentinstillsanespecialterrorwhichrequiresthedoctorsattentionandreassurance.,Whenexaminingsuchpatients,ifatallpossible,Oslersdictumshouldbefollowed:“Dothekindthinganddoitfirst.”,Example4,InfectionControlinSurgicalSettingsTheevolutionofmodernsurgeryhasreachedalevelwhereeveryorgancanbesuccessfullyinvaded,wheremonitoringdevicesdisplaythestatusofeveryphysiologicalactivity,andwhereagrowingnumberofdevicesandtransplantsexistthatcantemporarilyorevenpermanentlyreplacevitalorgans.,Onegreatlimitingfactor,however,threatensthesuccessofalmosteverysurgicalprocedureinfection.Infectionresultswhenmicrobesovercomethedelicatebalancebetweenthebodysnormalprotectiveimmunologicprocessandtheinvadingmicroorganismspathologicproperties.,Infectionisathreatnotonlytothenewandtechnicallyinnovativeproceduresdoneinlargehospitals,butisalsotheenemyofeventhesimplestprocedures,suchathosedoneinoutpatientsurgeryfacilities.Awoundinfectioncanbeasdevastatingtoaherniarepairoracutfingerasitcanbetoahearttransplantpatient.,Example5,AStatementofPathologicalConditionDr.LawrenceC.C.Wong(M.B.,B.S.,RGN)医学学士，外科学士，注册通科护士TOWHOMITMAYCONCERN致当事者,ThisistocertifythatLEERen-pinissufferingfrominfertility（不育症）,spermcount0-1/HPF（高倍视野）.Heismedicallyandphysicallynormal.Thereisnopathologicalabnormality，nosexuallytransmitteddiseaseseen.Heismedicallyfittoad