Case study:Mr. Jenaro is newly diagnosed with diabetes.

His hemoglobin A1C

is 10.3%. Mr. Jenaro is slightly overweight. He is 5 feet 10 inches tall and
weighs 174 pounds (79 kg). 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.” For the past few months, Mrs. Jenaro has
noticed that her husband “has been very thirsty and has been up and down to
the bathroom a hundred times a day.” Neither can recall how long it has been
since these changes in Mr. Jenaro began. Dolores states, “It has been quite a
while now. It just seems to be getting worse and worse.”
Questions:
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. Jenaro’s postprandial result, what is important to
consider regarding his age and tobacco use?
4. Explain what a hemoglobin A1C (HbA1C) lab test tells the health care
provider.
5. How might the nurse briefly explain what diabetes is in lay terms to Mr. and
Mrs. Jenaro?
Living wiil ,health care proxy or durable power of attorney
‫مااهمية هذا االجراء لمرضى الحاالت الحرجة او كبار السن‬
Differences Between a Medical Interpreter and a Medical Translator :
1- Medical translators often need to deal with paperwork and with the more formal side of
the medical world. They are required to know precise technical terms in each language to
make sure all the information in paperwork is correct, and thus need to go through medical
translation programs. It is important for medical translators to have a strong command of
both languages, because mistakes could even have legal repercussions
2- A medical interpreter essentially serves as a liaison between patients (who are not
proficient in English) and their care provider. Just like medical translators, they need to
know medical terms.  However, they are essentially  who make sure everyone understands
each other so that patients can get the right treatment. A Medical interpreter must have the
language skills to correctly interpret what both parties are saying, as the patient’s health is
dependent on it.
3- The training is different because these two jobs are so different in nature, those who
want to handle written work should do medical translation training, while anyone who
wishes to work with people in a medical setting should get  instead. In fact, it would be
helpful for interpreters to be certified in languages that are commonly spoken by
immigrant populations.

Q2 / Describe the following serum glucose tests used to help confirm the
diagnosis of diabetes mellitus: casual, fasting, postprandial, and oral glucose
tolerance test.
1- Casual glucose test : ( Random blood sugar ).  A blood sample will be taken at a
random time. Regardless of last ate . Random blood glucose level of 200 mg per dL (11.1
mmol per L) or greater , lower random blood glucose values (140 to 180 mg per dL [7.8 to
10.0 mmol per L]) have a fairly high specificity of 92 to 98 percent; therefore, patients
with these values should undergo more definitive testing. A low sensitivity of 39 to 55
percent limits the use of random blood glucose testing.
2- Fasting glucose test : A blood sample will be taken after an overnight fast or it is a
blood test done to measure the amount of glucose present in the blood after an eight-hour
fast. It is thus not affected by recent food intake.. A fasting blood sugar level less than 100
mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to
6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two
separate tests, patient have diabetes .
3- Postprandial plasma glucose (ppg) : postprandial means after a meal; therefore,
Postprandial concentrations refer to plasma glucose concentrations after eating. Many
factors determine the Postprandial profile. In non-diabetic individuals, fasting plasma
glucose concentrations (i.e., following an overnight 8- to 10-h fast) generally range from
70 to 110 mg/dl. Glucose concentrations begin to rise ∼10 min after the start of a meal as
a result of the absorption of dietary carbohydrates. The Postprandial profile is determined
by carbohydrate absorption, insulin and glucagon secretion, and their coordinated effects
on glucose metabolism in the liver and peripheral tissues.
4- Oral glucose tolerance test : This test, patient fast overnight, and the fasting blood
sugar level is measured. Then drink a sugary liquid, and blood sugar levels are tested
periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L)
is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates
diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates
prediabetes

Q3/ When evaluating Mr. Jenaro’s postprandial result, what is important to

consider regarding his age and tobacco use?
Smoking has been shown to acutely impair glucose tolerance and raise insulin levels
during an oral glucose tolerance test (OGTT) . In addition to this, acute smoking may
interfere with gastric and gallbladder motility, thereby influencing postprandial glucose .

postprandial rising glucose concentrations in the elderly compared with young men was

caused by lower rates of glucose disposal due to insulin resistance, impaired insulin
secretion, and increased hepatic insulin extraction. 

Q4/ Explain what a hemoglobin A1C (HbA1C) lab test tells the health care
provider?
Hemoglobin A1c is a measure of the degree to which hemoglobin is glycosylated in
erythrocytes and is expressed as a percentage of total hemoglobin concentration. It reflects
the exposure of erythrocytes to glucose in an irreversible and time- and concentration-
dependent manner. HbA1c levels provide an indication of the average blood glucose
concentration during the preceding 2–3 months, incorporating both pre- and postprandial
glycemia. Because blood glucose concentrations vary widely during a 24-h period and
from day to day in diabetes, the measurement of HbA1c is the most accepted indicator of
long-term glycemic control. However, the HbA1c level does not provide a measure of the
magnitude or frequency of short-term fluctuations of blood glucose, which are particularly
great in type 1 diabetes.

Q5/ How might the nurse briefly explain what diabetes is in lay terms to Mr.
and Mrs. Jenaro?
Diabetes mellitus (sometimes called "sugar diabetes") is a condition that occurs when the
body can't use glucose (a type of sugar) normally. Glucose is the main source of energy for
the body's cells. The levels of glucose in the blood are controlled by a hormone
called insulin, which is made by the pancreas

Or

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too
high. ... Insulin, a hormone made by the pancreas, helps glucose from food get into your
cells to be used for energy. Sometimes your body doesn't make enough—or any—insulin
or doesn't use insulin well.

Living will for old age or in critical unit :

A living will expresses end-of-life wishes and typically works together with a medical

Power of Attorney (POA). ... The medical POA allows the older adult to choose someone
to legally make medical decisions on their behalf. That person is called the healthcare
agent or proxy for healthcare decisions
 A health care proxy is a document whereby a person, referred to as the Principal,
appoints another person, referred to as the Health Care Agent, to
make medical decisions when the Principal is incapacitated and unable to make or
communicate such decisions.
 A durable power of attorney simply means that the document stays in effect if
person become incapacitated and unable to handle matters own. (Ordinary, or
"nondurable," powers of attorney automatically end if the person who makes them
loses mental capacity.)