Question

Mr. Gennaro is a 61-year-old Spanish-speaking man who presents to emergency room with his wife Dolores. Mr. Gennaro is also Spanish-speaking, but understand some English. Mr. Gennaro complains of nausea and vomiting for two days and symptoms of confusion. His blood glucose is 796 mg/dL. Intravenous regular insulin is prescribed and he is admitted for further evaluation. He will require teaching regarding his newly diagnosed diabetes.

He is a past medical history of coronary artery disease (CAD) and hypertension (HTN). Smokes one pack of cigarettes per day; tobacco use for 35 years. He also takes jerbero, and curandera.

Mr. Gennaro is newly diagnosed with diabetes. His hemoglobin A1c is 10.3%. Mr. Gennaro is slightly overweight. He is 5’10” tall and weighs 174 pounds. He reports no form of regular exercise. He does not follow a special diet at home. He states, “I eat whatever Dolores puts in front of me. She is a good cook.” Neither can recall how long it has been since these changes are Mr. Gennaro began. Dolores states, “it has been quite a while now. It just seems to be getting worse and worse.”

1. The nurse does not speak Spanish. Discuss what the nurse should keep in mind to facilitate effective communication using an interpreter. What is the difference between the role of a medical “interpreter” and that of a medical “translator”?

2. Describe the following serum glucose tests used to help confirm the diagnosis of diabetes mellitus: casual, fasting, postprandial, and oral glucose tolerance test.

3. When evaluating Mr. Gennaro’s postprandial results, what is important to consider regarding his age and tobacco use?

4. Explain what hemoglobin A1c lab test tells the healthcare provider.

5. How might the nurse briefly explain what diabetes is in lay terms to Mr. and Mrs. Gennaro?

Answer 1

1)Discuss what the nurse should keep in mind to facilitate effective communication using an interpreter?

*Interpreter Pre-Session

*The pre-session is an opportunity to be clear about the nature of the upcoming encounter and any particular concerns that the provider would like to address regarding the patient’s condition. This provides the interpreter with the information necessary to make any adjustments in his/her interpreting.

*Speak more slowly rather than more loudly.

*Speak at an even pace in relatively short segments. Pause so the interpreter can interpret.

*Be patient. Providing care across a language barrier takes time. However, the time spent up front will be paid back by good rapport and clear communication that will avoid wasted time and dangerous misunderstandings.

*Give the interpreter time to restructure information in his/her mind and present it in a culturally and linguistically appropriate manner. Speaking English does not mean thinking in English.

*Encourage the interpreter to ask questions and to alert you about potential cultural misunderstandings that may come up.

*Ask the patient to repeat back important information that you want to make sure is understood.

2)What is the difference between the role of a medical “interpreter” and that of a medical “translator”?

*An interpreter is a person specially trained to convert oral messages from one language to another. A translator is a person specially trained to convert written text from one language to another.

*Professional medical interpreters are trained to interpret the spoken word, whereas translators work with written words. Although the two professions are often confused, they require different skill sets, with interpreters working in live situations.

*The interpreter and translator’s job is to find an equivalent way of conveying the message with accuracy and completeness.

*Interpreters and translators can alert the creator of the original message to suggest a different approach. For example, if a provider is using complex medical terms that have no linguistic equivalent in the refugee patient’s language, the interpreter can ask the provider to repeat using less technical terms to express themselves.

3)Describe the following serum glucose tests used to help confirm the diagnosis of diabetes mellitus: casual, fasting, postprandial, and oral glucose tolerance test?

*For fasting glucose testing, collect the blood sample in the morning after an overnight or 8-hour fast.

*For postprandial glucose testing, collect the blood sample 2 hours after a regular meal.

*For oral glucose tolerance testing, after oral intake of 75 g of glucose, collect blood samples at 1 hour and 2 hours.

4)When evaluating Mr. Gennaro’s postprandial results, what is important to consider regarding his age and tobacco use?

* He is 61 year old. Peripheral vascular disease, heart disease and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status

*He is a chain smoker,Smokers are 30 to 40 percent more likely to develop type 2 diabetes than nonsmokers. Smoking can also make managing the disease and regulating insulin levels more difficult because high levels of nicotine can lessen the effectiveness of insulin, causing smokers to need more insulin to regulate blood sugar levels.

5)Explain what hemoglobin A1c lab test tells the healthcare provider.?

*The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures average blood sugar levels over the past 3 months.

*The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes and to monitor how well patient managing the diabetes

* Specifically, the A1C test measures what percentage of hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated).

*It’s one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and health care team manage your diabetes.

*Higher A1C levels are linked to diabetes complications

*For someone who doesn't have diabetes, a normal A1C level is below 5.7 percent. If your A1C level is between 5.7 and 6.4 percent, you have prediabetes (also called impaired fasting glucose), which means you have a high risk of developing diabetes in the future.

*If you have another form of hemolytic anemia, or if you've had a recent blood transfusion, this test would not be useful, as results may be falsely low.

6)How might the nurse briefly explain what diabetes is in lay terms to Mr. and Mrs. Gennaro?

*Nurse explains to Mr and Mrs Gennaro that he is having Type 2 DIbetis Mellitus in a comfartable way, without maiking him panic.

*She should inform basic details of Type 2 DM such as;

*Type 2 diabetes is a lifelong disease that keeps your body from using insulin the way it should. People with type 2   diabetes are said to have insulin resistance. People who are middle-aged or older are most likely to get this kind of diabetes. ..

*She should mention the Complication.Precuations,Medications ,its side effects ,Diet and Exersise....

*She should council him and to advice for a better physical and mental health to prepair the disease.