18. Describe the procedure of conventional surgery. What personnel are involved? What instruments are necessary? What documents does the orderly take into thea­ter?

Conventional or open surgery still remains a bloody business which involves cut­ting open the body, holding it open with retractors and putting both hands into the hole.

Conventional surgery is carried out in an operating theatre. It involves a surgeon and his assistant, an anaesthetist and his assistant, theatre and scrub nurses. Theatre nurse makes sure the table's set up, that they have everything they need such as gowns, gloves, soaps and brushes, waste bags, and stocks of swabs.

The orderly usually takes into the theatre such documents as notes, test results and consent form. The surgeon and his or her assistant wash or scrub up, and put on surgical gowns, masks and gloves. By the moment the patient is lying on the operating-table the anaesthetists gives him intratracheal anaesthesia and when the patient falls asleep the op­eration begins.

The surgeon treats the operative area with an antiseptic solution three times and sur­rounds it by a sterile cloth. Then he makes an incision with a scalpel. Bleeding is stopped with the clamps and then the surgeon performs all necessary manipulations in the opera­tion area. Next the surgeon cleanses the operative wound from exudates. Then the surgeon closes the abdominal wound in layers with drainage. A patch is stuck and an ice-bag is put on the wound for several hours.

When the operation is over the patient is taken on a stretcher cart to the post­operative room. In about two hours the patient comes round. If the patient survives the operation well, his general state is satisfactory. Thereafter the doctor in charge examines the patient every day to make sure the patient's post-operative course is uneventful. If no complications are noted and the wound is healing well the patient is usually discharged from the hospital in a fortnight.

Keyhole surgery is highly appreciated because it means less pain and less scarring - things that patients are mostly afraid of. For example, in conventional by-pass surgery the surgeon has to open the patient's chest with a 30 cm long incision whereas keyhole sur­gery involves just three one-centimetre cuts

.Discuss the importance of post-operative monitoring. What complications may occur? Explain how to rate and manage pain.

The fear of being in pain makes some patients unable to cope with idea of surgery. But the efforts of anesthetists are aimed to prevent feeling of pain during and after the operation because of their involving in all stages of surgery (pre-operative, operative and post-operative). Before the operation anesthetist connect patient to the monitoring equipment, then he gives some drugs that send patient to sleep, asks the patient sees is recovery room.

The following procedures are devoted to post-operative monitoring, the integral part of which is pain management. The procedure of pain management contains giving a pain relief while patient's waking up. Also there is a special apparatus PCA machine (patient-controlled analgesia) which is run through the pump. The medication goes into patient's bloodstream whenever he pushes the button. Even if patient keeps pushing the button the opportunity of giving overdose expelled: the pump is programmed so that the machine automatically blocks medication carrying out through line. It is called "a lock-out time" of giving medication. Patients are usually asked to assess their own pain level on a pain scale, in which "0" means absence of pain at all and "10" means the unbearable pain. This evaluation is quite subjective. That is why it is important to be clear about pain threshold and pain tolerance. The pain threshold is the point at which we all feel pain. Pain tolerance is more individual sensing of pain and can be affected by several things like cultural factors for instance. Some patients have a high tolerance and some - low tolerance for pain.

There are some analgesics which are used in acute post-operative pain. Analgesics act on different sites of the body and are therefore useful for the various types of post-operative pain: localized and referred. Localized pain is a fast pain which is felt at the site of surgical incision. Anti-inflammatory drugs are useful for this type of pain. For example opioids can be used to modify or change the transmission of nerve impulses in the dorsal horn. In this way, the opioid pre-empt painful nerve impulses before they cause discomfort. Paracetamol is used as a background drug to opioids. That is why pain management is about using several drugs together to obtain the best outcome.

Except for the procedures of pain management there are the other procedures strongly connected with post-operative monitoring. For example, taking patient's observations: temperature, pulse, blood pressure. It is usually performed by nurse. After the operation patients may be given an incentive spirometer-atri-ball to blow into. It is important to wait to prevent lung collapse by making sure the patient's lungs inflate as much as possible. This procedure is used to get lung function back after the anesthetic.

AH these post-operative procedures help to avoid a lot of complications in dangerous post-operative period. That is why they are indispensable and very useful both for patients and for the healthcare system

.14. Describe Great Britain: geographical position, political situation, populations, nations, history and the main sights.

The United Kingdom of Great Britain and Northern Ireland occupies territory of the British Isles which are situated to the north-west of Europe. They consist of two main islands: Great Britain and Ireland and 4 sub-countries: England, Scotland, Wales & Northern. Its washed by the Atlantic Ocean, by the North Sea. The Irish Sea, the North Channel and the St. George's Channel. Great Britain is separated from France by the English Channel, which is 32 km wide in its narrowest part. In everyday speech "Great Britain" is used to mean the UK.

Weather changes very often. The climate of Britain is mild, humid and changeable. The most characteristic feature of Britain's weather is its variability. Summers are not hot and winters are not cold in Britain. The snow never lies for long on the ground. As a rule there is no ice on the waters of rivers and lakes.

English is the official, but not the only language used in the country.

Britain has been many centuries in the making. The Romans conquered most part of Britain, but were unable to subdue the fiercely independent tribes in the West and in the North. Further waves of invaders followed: Angels, Saxons, Jutes, Vikings and Normans. All these contributed to the mixture we call English. For many centuries this country was known simply as England. It had a strong army and navy. It waged numerous colonial wars. England, once the "work shop of the world", was the first to become a highly industrial country.

There are no big rivers in Great Britain. The biggest are Severn and Thames. The Severn in England is the longest river. It is 350 kilometers long. There are a lot of mountains in Great Britain, but they are nit high. The highest mountain - Ben Nevis - is in Scotland. The flora of the British Isles is much varied and the fauna is similar to that of the north-west of Europe. The country is not veiy rich in natural resources but there were enough for the Industrial Revolution to start.

Great Britain is highly industrialized, this was the country in which the earliest developments of modem industry.

The Great Britain is a parliamentary monarchy. British laws are made in the House of Lords and the House of Commons.

London is the capital of the Great Britain. It was founded by the Romans. It is veiy old city. It is two thousand years old. London is only the capital of the countiy; it is also a huge port.