NEED OF A PRE-SESSION

Only first name, and your id number (being given to u by your companny)

We use our Audio instead of a hand. USe the voice to interjext

---------------------------------------------------------
For the Provider :

"Goodmorning, My name is Renzo, My id is (2402) and I will be your interpreter

today. "

I will interpret everything that is said

Please, speak in short sentences and with frequent pauses

The interpreter might interject if a pause is needed "

"How may i help you?"

For the target language:

" Buenos dias, Mi nombre es Renzo, Mi id es (2402) y seré su interprete el día de

hoy "

"Por favor, hable directamente al dr , yo interpretaré todo lo que usted diga "

"Por favor, hable en oraciones cortas y con pausas frecuentes

El interprete tal vez tenga que intervenir si una pausa es necesaria. "

" Todo en la sesión se mantendrá confidencial. "

------------

INTERPRETATION

- or the nightor the morning of water gum

dsdas

do not smoke sdok

plz notify ur dr if u develop any sign of illness prioor to ur surger need to

report symphtons hifhg fever sor ethorat or other
infecions breathing dificulties or any chest pain

yes, u shoudl shower or bathe night before or the morning on ur surge. do not put
lotion

what should i wer

wear loose and comforetable clothes X

plz leav all jew at home, if you have glasses or piercings

absolt not, for your safety ,u will not b permited to take public transoportation
or drive home. not drive any machinary for 24 hours
after recieving anestesia

a responsible adult muste be present to acompany u to ur home

srtongly sugest all patients home at home the 24 hours after surgery

plz tall all ur routing morning medication ,with just a sip of water the moment u
get up in the morning
medication for blood presure, heart water pills, ifdiabetics dont take ur meds or
insuline, bring those instead
----------------------------

2. The physician's method - Part 1

Healthcare providers usually follow a method to solve medical problems, usually in
four stages:

Collection of information: patient history and testing

Diagnosis: all pieces of information are analyzed

Treatment plan: design and implementation

Patient education: from simple instructions to complex follow-up.

3. The physician's method - Part 2

This process is not unidirectional.

In many instances, patients need to go through additional rounds of testing due to

findings that were previously unknown and that may influence the health status of
the patient.

4. Collection of information - Part 1

Healthcare providers need to collect several pieces of information to determine the
overall cause(s) of the problem.
Part of this work entails collecting patient information using a written source,
such as patient intake forms. However, the key to collecting patient information is
the oral interview with the patient.

Collection of information - Part 2

Written forms are often made available to the patient in advance, either online, or
through regular mail.

The purpose of collecting this information is to establish a baseline knowledge of

the patient’s family, medical, and social history.

This is mostly true when patients initiate care with a new family physician or
clinic, or when visiting a health system that is not interconnected with the system
where the patient’s information is stored.

Collection of information - Part 3

Collecting information includes finding and verifying anatomical and physiological

signs and symptoms, and biochemical levels to determine the possible cause of the
chief complaint, or to establish a primary care history for routine care.

The chief complaint is the primary source of pain or discomfort motivating the
patient to seek medical care.

The most common methods of collecting information include, but are not limited to
patient intake forms, the medical interview, and blood and imaging testing.

Diagnosis

Once information is collected from different sources, the health care providers
usually determine a diagnosis of the patient’s problem.

At this point, it may be necessary to conduct additional testing, depending on the

initial results.

Treatment plan

After diagnosis, physicians devise a treatment plan to improve the patient’s health
outcome by addressing the cause(s) affecting the patient.

A treatment plan can be as simple as a round of antibiotics, or as complex as

extensive surgeries, procedures, and rehabilitation therapies.

Patient education

Regardless of the length or complexity of the treatment plan, the patient is an

integral component in following the treatment plan.

For that reason, patients are educated on the guidelines and instructions to follow
for a proper, continuous, and safe implementation of the treatment plan.

LEP patients
LEP patients tend to suffer the consequences of ineffective communication.

The first source of confusion may well be the units of measurement used in the US
that are used in only two other countries in the world (See Figure 24 on page 99).

Without the use of a culturally competent medical interpreter, the patient may have
no idea what the US measurements mean.

The medical interview - Part 1

The medical interview is by far the most important tool a physician has to collect
useful information from the patient’s medical, family, and social history.

For LEP patients, the medical interview tends to be a major barrier to properly
communicating their chief complaint and other aspects related to their health.

Lack of effective communication that goes beyond the language barrier usually
happens when there is a significant difference in the register used by either
patient or provider.

The medical interview - Part 2

For example, a typical question during a medical interview is: “please describe the
type of pain you’re feeling.”

The physician is expecting an answer based on a list of common pain descriptors,

such as sharp, pressing, acute, shooting, etc (Refer to Pain Descriptors Table on
the CMIT™ Textbook pages 104-105).

However, the patient typically identifies the question with the intensity of the
pain: mild, medium, or strong. The difference is based on the fact that patients
are not used to using explicit pain descriptors. Nor are they used to the very
commonly-used 1 to 10 pain scale, especially for those who have arrived in the US
fairly recently.
The pain scale usually goes from zero (0) or one (1) meaning absence or minimum
pain to ten (10) as a form of extreme pain. Sometimes providers show patients the
scale with an image (see below).

-----------------

The basics of the medical interview

In the previous activity, you reviewed a typical scenario where physician and
patient exchange information. This exchange of information is usually systematic
and organized by the physician with the purpose of collecting pertinent information
based on the reported patient's chief complaint.

The dialogue between Mrs. Martinez and Dr. Lee is an example that illustrates how a
doctor trained in western medicine switches his or her line of questioning to try
to pinpoint the body system that is causing the patient their problem.

Knowing how this works will help the interpreter anticipate seemingly rapid changes
in questioning.

-------

Chief CONCERN - History of person illness or HPi , reason that drives person to
seek care.

ACROSS THE COUNTER - generalmente significa obtener algo sin necesidad de una
prescripción médica, es decir, comprar un medicamento directamente en una farmacia
sin necesidad de receta.

PULL the muscle - tiron muscular

Pain descriptors
Many medical interviews entail describing some form of pain that patients are
suffering. Physicians usually ask patients to "describe the pain." The intention of
the physician is to identify characteristics of the pain that can help him/her to
determine the anatomical or physiological processes that may be causing the pain.

However, most patients respond to that question with a brief description of the
intensity or magnitude or the pain with phrases such as "it hurts a lot" or "it
hurts a little."
The reason of this discrepancy is that patients do not use pain descriptor on a
regular basis. Pain descriptors are not common knowledge, because it is part of
medical language. Therefore, most of the time, patients need to be guided to use
the pain descriptors that the providers need to differentiate the sources or causes
of pain.

Complete the tables of pain descriptor located on pages 104 and 105 of the CMIT
Textbook.

-----------------

Digestive system: The basics

Digestion is a metabolic process and our body's way of using digestive substances
(juices, enzymes, acids) in our mouth, stomach, and intestines to change the food
we eat into substances that the body needs (energy and building molecules).

The digestive process starts in the mouth with a mechanical process (chewing), and
a chemical process (saliva's amylase enzyme).

This is a brief summary of the digestion:

Mouth→ epiglottis closes→ esophagus → stomach→ small intestine→ large intestine→

rectum→ anus

What is the function of the epiglottis?

The epiglottis is a small structure at the bottom of the tongue that helps direct
food down the esophagus (digestive system), and not down the trachea (respiratory
system).

Digestive system: The food journey

Mouth: Oral cavity. It contains the tongue, teeth and salivary glands. Saliva
contains enzymes that help initiate the digestive process.

Pharynx: Part of the digestive and respiratory systems. Food enters the pharynx on
its way to the esophagus.

Esophagus: It’s a flexible tube that lubricates the food with mucus on its way to
the stomach.

Diaphragm: A muscle, dividing the chest from the abdomen.

Stomach: a pouch where food is exposed to acids and enzymes to continue breaking
down macromolecules into smaller and smaller molecules in preparation for nutrition
absorption
in the next portion of the digestive tract, the intestines.

The small intestine, most nutrient absorption from the food we eat happens in the
small intestine, leaving mostly waste for the large intestine.
It has three parts: duodenum, jejunum and ileum. Food then moves into the large
intestine.

The large intestine, it receives the waste from the small intestine, it absorbs
water, and changes the rest to feces so we can expel them.
It has four parts: cecum (appendix is attached to it), colon (ascending,
transverse,and descending), sigmoid, and rectum.

Digestive system: Common procedures

Common procedures

Endoscopy Colonoscopy

Upper GI series (Barium swallow)

Lower GI series (Barium enema)

Common disorders

Appendicits Cholecystitis
Cholelithiasis

Cirrhosis

Diverticulitis
Diverticulosis
Fatty Liver Disease
Gastric cancer

Gastritis
Gastroesophageal Reflux Disease (GERD)

Gum disease

Heartburn
Hepatitis
Hiatal Hernia

Inflammatory Bowel Disease (IBD) Stomatitis

Ulcers

--------------------------
Endocrine system: The basics
The Endocrine System
Functions

- It maintains homeostasis (body's equilibrium)

- It controls the body metabolism: Catabolism (breaking down), Anabolism (building

up)

- It controls the overall functioning of the body

Glands
- The organs that produce hormones are called glands. Examples: stomach, pancreas,
brain, ovaries, etc.

- Overactive glands: glands that produce more hormones, or are more active than
expected. Example: Hyperthyroidism

- Underactive glands: glands that produce less hormones, or are less active than
expected. Example: Hypothyroidism

Hormones
- They are chemical messengers made up of proteins, carbohydrates, etc.

-----

Endocrine system: Hormonal regulation system

How are hormones controlled?

Positive feedback:

Stimulus (baby sucking) → Receptor (Hypothalamus in the brain) → Hormone (Oxytocin)

released by gland (posterior pituitary-brain) → Milk production

Negative feedback

Stimulus (TRH from Hypothalamus) → Receptor 1 (anterior pituitary-brain) → Hormone

(TSH) released → Receptor 2 (Thyroid) → Produces T3 & T4

Legend:

TRH = Thyroid Releasing Hormone

TSH = Thyroid Stimulating Hormone

T3 = Triiodothyronine

T4 = Thyroxine
------

Endocrine system: Hormones by organ

Organ Hormone(s)
Hypothalamus

Thyroid

Parathyroid

Thymus

Pineal gland

Melatonin

Adrenal (Suprarenal) glands - Cortex

Adrenal (Suprarenal) glands - Medulla

Ovaries

Testicles

Stomach

Pancreas

---------------
Common disorders
Gland Hormone Low/High Disorder
Pituitary Growth Hormone (GH)

Growth Hormone (GH)

Antidiuretic Hormone (ADH)

Low

High

Low
Dwarfism

Gigantism/Acromegaly

Diabetes insipidus
Thyroid T3, T4

T3. T4
Low

High

Hypothyroidism, Hashimoto, Goiter

Hyperthyroidism, Graves, Goiter, Thyromegaly

Adrenal
Cortisol

Cortisol

Epinephrine
Low

High

High
Addison disease

Cushing disease

Pheochromocytoma
Pancreas
Insulin

Insulin
Low

High
Hyperglycemia, Diabetes types I and II

Hypoglycemia
Gonads Estrogen

Testosterone
High
High
Gynecomastia

Hirsutism

-------------------------

a cure to apendicitys has been treatetd like a emergencia quirurjiga por decadas
hasta ahora
con vastos buenos resultados

pero cirujia rs realmente la unica? o los antibioticos en vez?

esa fue una pregunta hecha en una reciente investigacion publicada, por redomdtopm
miller un interno medico de jhonos hoptkins

ellos hicieron un randomize control trials , 530 patients with complicated acute
apendicitis by ct and randomized them byt antibitoics therapy for 10 days vs
apendectomy
loq encontraron 273 personas ciirujia todos menos 1

256 - 186 de las personas q recibieron los antibioticos mejoraron , lo cual sria
72.7 % 20% q eventualmente necesitaron intervencion quirurjica- no tuvieron un
mal final

miller dice que investigacion adicional deberia determinar si acaso antibioticos

pueden curar la apendicitis, desde jhon homptkins, soy elizabeth tracy