APA 7th edition references PER ANSWER within the last 5 years. Graduate level answer.

The selected disease process is cirrhosis which is a liver disease that occurs when scar tissue replaces healthy tissue preventing the organ from working normally. An injured tissue is replaced by a scar, known as fibrosis which often takes months or years of ongoing injury. The underlying pathophysiological mechanism of cirrhosis is the development of scar tissue that leads to the replacement of normal liver parenchyma causing blockage of portal blood flow and disruption of normal liver function. When fibrosis reaches a point where distortion of the hepatic vasculature occurs, it is called cirrhosis (Jagdish et al., 2023). If the damage continues, panlobular cirrhosis may occur. The cellular mechanisms responsible for cirrhosis are similar irrespective of the type of initial insult and the injury site within the liver lobule. The clinical manifestation observed in Bayani’s case that could be explained by the pathophysiological mechanisms of cirrhosis is foul-smelling urine. This is due to the liver’s inability to filter waste products effectively leading to a build-up of ammonia in the blood causing a strong, ammonia-like odor in the urine.

The clinical manifestations of cirrhosis depend on the advancement of the disease. The common early signs and symptoms are fatigue, loss of appetite, nausea, weight loss, itchy skin, and upper abdominal pain (Wu et al., 2024). The later signs and symptoms related to portal hypertension and declining liver function are vomiting blood, disruption in the menstrual cycle, jaundice, gallstones, dark-colored pee or stool, edema, blood in the stool, low urine output, shortness of breath, ascites and digestive difficulties. In Bayani’s case, the clinical manifestations that can partially support a diagnosis of cirrhosis are foul-smelling urine, abdominal pain which is caused by a buildup of fluid in the abdomen (ascites), and mild confusion which occurs when a damaged liver cannot properly filter toxins causing them to build up in the brain leading to cognitive changes.

The diagnostic tests that would be most appropriate for investigating a diagnosis of cirrhosis in Bayani’s case are physical examination, blood tests, imaging tests, and liver biopsy. A physical examination focuses on checking the medical history of Bayani, and the signs and symptoms related to cirrhosis. The blood tests for the disease include CBC, liver tests, and viral infection tests. For instance, liver tests can measure liver products like enzymes, proteins, and bilirubin levels in the blood to confirm cirrhosis. Imaging tests include MRI, CT scan, and abdominal ultrasound that show detailed images of the size, shape, and texture of the liver to confirm cirrhosis (Wu et al., 2024). A liver biopsy is a small procedure that involves taking a sample of the liver for examination to diagnose cirrhosis. Type 2 diabetes is a condition that causes high blood sugar levels because the body does not produce adequate insulin. In Bayani’s case, the clinical manifestations that can partially support the diagnosis of type 2 diabetes are mild confusion often known as brain fog, abdominal pain, frequent water drinking and urination, and foul-smelling urine due to the production of ketones excreted in the urine.

References

Jagdish, R. K., Roy, A., Kumar, K., Premkumar, M., Sharma, M., Rao, P. N., Reddy, D. N., & Kulkarni, A. V. (2023). Pathophysiology and management of liver cirrhosis: From Portal hypertension to acute-on-chronic liver failure. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1060073Links to an external site.

Wu, Z., Chen, L., Chen, J., & Chen, C. (2024). Management of liver cirrhosis and its complications. Liver Cirrhosis and Its Complications – Advances in Diagnosis and Management. https://doi.org/10.5772/intechopen.1005466Links to an external site.

Mrs. Demetilla Hernandez is a 63-year-old Cuban woman who seeks consultation at the Liberty health-maintenance organization (HMO) clinic because of weakness, lethargy, and fatigue that she has experienced for the last 2 months. A week ago, while cooking dinner at her daughter, Mariana’s house, she momentarily lost her balance and slipped on the kitchen floor. Although Mrs. Hernandez sustained only a mild bruise on her leg, her daughter insisted on taking her to the clinic for a check-up because of her persistent symptoms.

Mrs. Hernandez, widowed 4 years ago when her husband died of a heart attack, lives with Mariana, aged 40. Mariana is divorced and has three children: Luis, age 15; Carolina, age 10; and Sofia, age 7. Since moving into Mariana’s house, Mrs. Hernandez has been managing the household while Mariana is at work. Mrs. Hernandez prepares the family’s meals, attends to the children when they come home from school, and performs light housekeeping chores. Mariana is employed full-time as a supervisor at the local telephone company. The family, originally from Cuba, has been living in Miami for 12 years. Carolina and Sofia were born in Miami, but Luis came from Cuba with his parents when he was 3 years old. Mrs. Hernandez, who does not speak English, converses with her daughter and grandchildren in Spanish. Although the children and their mother occasionally speak English among themselves, the family’s language at home is Spanish.

At the Liberty HMO clinic, Mrs. Hernandez was diagnosed with essential hypertension and non–insulin-dependent diabetes mellitus. The physician prescribed an oral hypoglycemic drug and advised Mrs. Hernandez to exercise daily and to limit her food intake to 1500 calories a day. Mrs. Hernandez was concerned because she usually prepares traditional Cuban meals at home and was not sure whether she could tolerate being on a diet. Besides, she explained to Mariana, she thought the dishes she prepares are very “healthy.” Proof of that, she stated, is that her three grandchildren are plump and nice-looking. Mrs. Hernandez told her daughter that, instead of buying the prescribed medicine, perhaps she should go to the botanica and obtain some herbs that would help lower her blood sugar.

1. What are the typical Cuban communication patterns you need to be aware of in dealing with Mrs. Hernandez?
2. How would you assist Mrs. Hernandez in developing a plan for a 1500-calorie diet and regular exercise?
3. Would you encourage Mrs. Hernandez to go to the botanica to purchase some herbs? How would you approach her desire to use herbs instead of the prescribed oral hypoglycemic agent?
4. Discuss some common folk practices that Cuban families may use to maintain health or cure common ailments.