First patient, first clinicals, first work w/ real patient - Where do I start?

[simply_viki]

The last couple weeks of clinicals have been spent collecting patient data from the charts. I have my patient's history and lab values and medical diagnoses. She has a history of CVA and TIA, diabetes, and a bunch of other stuff. According to her chart, she has or has had difficulty speaking (obviously a result of the CVA), and on top of that, her primary language is Creole (I speak English only). I have only briefly met her, no assessment or anything. I did observe that she has some sort of involuntary movements of her head and limbs, I'm not sure what to make of it (I didn't see anything that exactly matched in my assessment book).

Anyway, I'm just really nervous, because I'm really just not sure how to even begin assessing a patient with whom I can't communicate. Fortunately, I have a classmate who speaks Creole, so I'm hoping I can get her to explain to the patient who I am and why I'm there, and what it is I will be likely doing (which I'm not even entirely sure of yet anyway), so she'll at least be more comfortable or at ease. That's if she can even communicate in Creole. When I introduced myself and asked her if she was Mrs. (X), she repeated her name, so I guess she understood that I was introducing myself. I couldn't understand anything she said except "OK" when I asked how she was doing, but she did try to say something else, and I couldn't make out if it was simply bad pronunciation, or another language (Creole), or both. But even with that other student, I know it's not going to be feasible to have her there interpreting the whole time, since she has her own patient to work with.

I don't know where to start in assessing. I'm planning to look up symptoms of her medical diagnoses and look for whatever symptoms are present. I don't know what else to do, especially with such a barrier in communication. I know it's not impossible since sometimes the patient can't even speak at all, regardless of language, but I don't really knnow what to do.

[Daytonite, BSN, RN]

assessment consists of:

• a health history (review of systems)
  
• performing a physical exam
  
• assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
  
• reviewing the pathophysiology, signs and symptoms and complications of their medical condition
  
• reviewing the signs, symptoms and side effects of the medications they are taking
  

you've got much of her medical history. check her meds and treatments. get as much data as you can for your care plan. when you have a translator there make sure you have them explain to the patient what you will be doing for the patient and what you need the patient to do for you. you might want to make a list of these things and questions tonight and have it ready for the translator. ask for a telephone number of a family member who can speak english and creole who you can call at any time in case you need to ask for help translating. then observe this patient closely. performing a physical exam can be accomplished by making motions with your hands of what you want to do. at some point, give the contact relative a call and ask them assessment questions as well. how much you wanna bet someone shows up to spend some time with her because of her language barrier? by the way, if communication is a problem the nd for that is impaired verbal communication r/t (see the etiologies for this diagnosis) aeb failed communication efforts despite the use of translators.

gotta love the challenges of nursing!