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CASE STUDY 1 Mr. Mendes GENDER DISABILITY u uses a whee\chair;…



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Mr. Mendes





u uses a wheechair; needs assistance with activities of daiiy living (ADLs)




u Admitted from a rehabilitation health care center







Language barrier  



PREEXISTING CONDITIONS                                                          u Use of a medical interpreter


u Peripheral vascular disease (PVD); type diabetes; below the knee amputation

(BKA, B-K amputation) of left leg two E Use of a medical interpreter weeks ago



Left lower iobe pneumonia







Non-English speaking

Level of difficulty: Easy

Overview: This case challenges the nurse to identify strategies to help overcome a language barrier and forrn a therapeutic nurse—client relationship. Legal and ethical concerns regarding the use of an interpreter are considered. Stump care for the client with a recent amputation is discussed.


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 prescribed. The nurse assigned to care for Mr. Mendes does not speak Portuguese.

Case Study Mr. Mendes requires finish 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.



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

  1. Explain the difference between a medical

“interpreter” and a medical “translator.”

  1. 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)
  1. Briefly discuss how Mr. Mendes’s past medical history relates to his below-the-knee leg amputation.

What is the benefit of havinga below-the-knee (B-K) amputation versus an above-the-knee (A-K) amputation?

  1. 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 ifyou put it up it on

are not the preferred interpreter(s).some pillows will feel better.” Provide a rationale for



4. Describe a therapeutic nurse—client relationship. Mr. Mendes’s request. Should the nurse elevate his stump on pillows as requested? S’Vhy or why not?

5. The nurse does not speak Portuguese. Discuss nonverbal strategies the nurse can implement 9. Mr. Mendes has not yet been fit for a prosthesis,
to help develop a therapeutic relationship with The nurse provides care ofhis stump. Briefly discuss
Mr. Mendes. the nurslng interventions Involved in stump care.
6. Provide the most likely explanation for why What outcome goals does the nurse hope to achieve through proper stump care?
Mr. Mendes presented with an acute change in mental status. 10, List five nursing diagnoses appropriate to

consider for Mr. Mendes’s plan of care.

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