You are working in the free clinic when father x comes in. you know him well; he is a type 2 diabetic who keeps his sugar under control with diet and exercise but is often in the clinic with homeless patients from the shelter he runs in the episcopalian church down the block.
on this visit, father x has brought in a thin man in his twenties named joe. joe appears confused and lethargic. he is breathing heavily and has a strong fruity odor. father x tells you he is concerned about joe because last night joe was up every half-hour or so to use the bathroom and get water. father x knows these are signs of diabetes, so he wants to get joe checked out. he also tells you that joe has not been drinking; they have a breathalyzer at the shelter, and joe tested clean when he checked in the night before.
joe's blood pressure is a little low at 95/60 mm hg and his heart rate is a little high at 96 bpm. when you take his pulse, you notice that his skin is dry and "tents" up when pinched − a sign of dehydration. his respirations are more rapid than normal, 25 breaths/min, and heavy. his blood glucose is elevated at 320 mg/dl. his urine also contains glucose, and has a lower ph than normal. when you take his history he tells you that type 1 diabetes runs in his family.

many of joe's signs and symptoms can be related to the loss of glucose in his urine. normally, urine does not contain glucose. when plasma glucose levels are elevated, however, some of the glucose from the plasma passes into the urine. apply the principle of osmosis to explain why joe was getting up all night to use the bathroom and why he has low blood pressure and signs of dehydration.

choose the most accurate explanation for joe's problem.

a. the frequent urination is happening because the urine contains a large volume of glucose. the loss of glucose from his plasma has decreased his blood volume.
b. the frequent urination is happening as part of a feedback loop to regulate his blood volume. it does not have anything to do with his plasma glucose.
c. the frequent urination is happening because his kidneys have stopped working. the kidney failure leads to low blood pressure.
d. the frequent urination is happening because when glucose moved into his urine, water also followed it. this removed water from his plasma, decreasing his blood volume and dehydrating him.

D. The frequent urination is happening because when glucose moved into his urine, water also followed it. This removed water from his plasma, decreasing his blood volume and dehydrating him.

Explanation:

Joe has diabetes mellitus, to regulate the high levels of glucose in the blood the body has to eliminate the excess of glucose through urine. To move the glucose to the urine, water has to move with the glucose. When this happens, the water in the blood decreases causing dehydration, that is why Joe is so thirsty, with dry skin, low pressure and presents the rest of the symptoms mentioned.

low context culture   (lc.):

association:    

relationships begin and end quickly. many people can be inside one's circle; circle's boundary is not clear.

things get done by following procedures and paying attention to the goal.

one's identity is rooted in oneself and one's accomplishments.

social structure is decentralized; responsibility goes further down (is not concentrated at the top).

interaction:

low use of nonverbal elements. message is carried more by words than by nonverbal means.

verbal message is explicit. context is less important than words.

verbal message is direct; one spells things out exactly.

communication is seen as a way of exchanging information, ideas, and opinions.  

disagreement is depersonalized. one withdraws from conflict with another and gets on with the task. focus is on rational solutions, not personal ones. one can be explicit about another's bothersome behavior.

territoriality:

space is compartmentalized and privately owned; privacy is important, so people are farther apart.

temporality:

things are scheduled to be done at particular times, one thing at a time. what is important is that activity is done efficiently.

change is fast. one can make change and see immediate results.

time is a commodity to be spent or saved. one’s time is one’s own.

learning:

reality is fragmented and compartmentalized. one source of information is used to develop knowledge. thinking is inductive, proceeds from specific to general. focus is on detail.

learning occurs by following explicit directions and explanations of others.

an individual orientation is preferred for learning and problem solving.

speed is valued. how efficiently something is learned is important.

hope that                                         : )