Mr. Mendes is an 81-year-old man who speaks only Portuguese. He is quite frail, weighing only 110 pounds. He had a below-the-knee amputation of his left leg two weeks ago. Mr. Mendes has been admitted to the hospital from a rehabilitation center with an acute change in mental status and diminished lung sounds in the left base. Mr. Mendes is diagnosed with left lower lobe pneumonia and antibiotic therapy is pre- scribed. The nurse assigned to care for Mr. Mendes does not speak Portuguese. 

Mr. Mendes requires complete an assistance with activities of daily living (ADLs). A medical interpreter is not assigned to the nursing unit; but, if needed, the nurse can ask a Portuguese-speaking nursing staff member to help interpret what Mr. Mendes is trying to express. However, the nurse still must develop a way of communicating with Mr. Mendes so the nurse can assess Mr. Mendes's level of comfort, provide care, and identify any needs. 

1. Briefly discuss the challenges of developing a nurse-client relationship when a language barrier exists between the client and nurse. 

2. Explain the difference between a medical "interpreter" and a medical "translator." 

3. Family members are often willing to interpret for the client and are more readily available. Discuss the use of medical interpreters and why, legally and ethically, family members (or friends of the client) are not the preferred interpreter(s). 

4. Describe a therapeutic nurse-client relationship. 

5. The nurse nonverbal strategies the nurse can implement to help develop a therapeutic relationship with Mr. Mendes. 

6. Provide the most likely explanation for why Mr. Mendes presented with an acute change in mental status. 

does not speak Portuguese. Discuss 

7. Briefly discuss how Mr. Mendes's past medical history relates to his below-the-knee leg amputation. What is the benefit of having a below-the-knee (B-K) amputation versus an above-the-knee (A-K) amputation? 

8. The interpreter tells the nurse that Mr. Mendes would like the nurse to remove the bed linens from his left foot and raise his leg on pillows. He states, "My foot aches and maybe if you put it up it on some pillows will feel better." Provide a rationale for Mr. Mendes's request. Should the nurse elevate his stump on pillows as requested? Why or why not? 

9. Mr. Mendes has not yet been fit for a prosthesis. The nurse provides care of his stump. Briefly discuss the nursing interventions involved in stump care. What outcome goals does the nurse hope to achieve through proper stump care? 

10. List five nursing diagnoses appropriate to consider for Mr. Mendes's plan of care. 

 

Answers:

1. Language barriers contribute to reducing both patient and medical provider satisfaction, as well as communication between medical providers and patients. Can have an impact on provision of care to the patient. Might as well with the patients comfort and trust. 

2. Medical Interpreter provides medical translation services to non English speakers. they help patients communicate with medical staff, doctors and nurses, Medical interpreter works in many facilities like nursing homes, rehabilitation facilities and mental health clinics.

Medical Translator are responsible for interpreting and translating an assortment of medical information. Common translation include patient information, diagnoses or pharmacological instructions. 

3. According to the code of ethics, for medical translators, information from a source language is to target language bear tremendous responsibility. They must conduct themselves in a professional manner regardless of the type of information that is being translated or interpreted. There is some reliance that a patients family members or friends can or should appropriately serve as interpreters, may themselves have limited English language abilities and may be completely unfamiliar with medical terminology. 

4. Therapeutic nurse-client relationship is defines as helping relationship that's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to others, and assisting with the gratification of your patients physical, emotional and spiritual needs through your knowledge and skills. 

5. Non verbal communication may learn more from a person's gestures than from the words being spoken, This may include; facial expressions, body movement and posture, gestures, eye contact, touch, space, voice.

6. Acute changes in mental health status are usually secondary to delirium, stupor and coma which are forms of acute brain dysfunction. These changes occur over a period of hours or days and usually precipitated by an underlying medical illness that is potentially life threatening. 

7.An attempt has been made to rationalize the selection of the site of amputation for gangrene in primary peripheral vascular disease. There is a good chance of the survival of a below knee stump if the circulation in the skin of the proposed flaps appears adequate clinically, and id the blood supply of the muscles is obviously good at amputation. If the popliteal pulse is present before operation, a below the knee amputation should succeed. The absence of popliteal pulse, however, does not exclude below knee amputation. Below knee stumps should be about four inches long in amputations for peripheral vascular disease. Test for determining the state of the circulation are also necessary before choosing the level for above knee amputation. 

8. I may not allow his request. Do not put a pillow under your leg. Although this may provide comfort for a short amount of time, a pillow can elevate the leg which makes it harder for the circulatory system to pump blood through the stump. This can make the amputation site more prone to infection or complications.

9. Impaired physical mobility related to loss of a limb (particularly a lower extremity) 

Desired outcome: Patient will verbalize understanding of the individual situation, treatment regimen and safety measures.  

Nursing interventions:

-Encourage patient to perform prescribed exercises

-Provide stump care on a routine basis; inspect the area, cleanse and dry thoroughly and rewrap stump with an elastic bandage

-Measure circumference periodically

-Rewrap stump immediately with elastic bandage 

-Assist with specified ROM exercises for both the affected and unaffected limbs 

-Maintain knee extension

-Provide trochanter rolls as indicated

-Instruct patient to lie in the prone position as tolerated at least twice a day with a pillow under the abdomen

-Caution against keeping the pillow under a lower extremely stump or allowing BKA limb to hang dependently over the side of the bed or a chair

-Demonstrate and assist with transfer techniques and use of mobility aids like crutches or walker

-Assist with ambulation

-Instruct patient in stump-conditioning exercises

-Refer to the rehabilitation team

-Provide foam or flotation mattress

10. Impaired physical mobility related to loss of a limb, Disturbed body image related to permanent alterations in structure and function of the left leg.  Risk for infection related to inadequate primary defenses (broken skin, traumatized tissue), Risk for ineffective tissue perfusion, Situational Low self esteem.