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    Neuro Ch 14 Study Guide

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    Neuro CH 14 Study Guide

    Diunggah oleh

    Michael J Miller
    Neuro Ch 14 Study Guide

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    Christensen: Adult Health Nursing, Sth Edtion 46 Study Guide Answer Key Noninfectious Ear Disorders Clinical Disorder Cause “Manifestations Diagnostic Tests ‘Treatment ‘Otosclerosis | Formation of spongy | Chronic progressive | Rinne test Stapedectomy bone around the oval | deafness, low-to Otoscopy test window mediumpitch tinnitus | Schwartz's sign, Andiometrc testing, Weber's test Ménitre’s | Unknown, occasionally | Recurrent episodes | Teststorule out CNS | No specific therapy, disease may follow a middle | of vertigo, nausea, | disease, audiogram, | fiid restriction, ‘ear infection tinnitus, hearing loss, | glycerol test diuretic, low-salt diet vomiting, dinphoress, Dramamine and nystagmus Aativert may be prescribed Patient Teaching 13, Encourage verbalizaton of specific concerns, Pro- + Byer Proper hygiene and eye care techniques to ensure that medications, dressings, and surgical ‘wounds are not contaminated Note sign and symp- toms of infection and repor them. Follow postoper- ative directions for postion, coughing, bending, and ‘Volsalva maneuver to prevent increased intraocular pressure, How tonsil eye drops. Take pain medi- cations as needed. The importance of follow-up care. + Bar: Protect ear canal during showers (cotton in ear canal, or use shower cap). AVoid swimming dur- ing infection and in contaminated water. Continue antibiotic therapy for prescribed number of days Get treatment for upper respiratory tract infections, ‘Use correct eardrop installation or irrigation, as prescribed. Wash hands before and after chang ‘ng cotton plugs. Keep external ea clean and dry. Fever and a return of ear pain or drainage should be reported at once, Multiple Choice Ta ar 33 al Critical Thinking Activities Activity 1 1. Monitor pressure dressing over ee. The dressing, should be inspected a least every hour ‘Assess for pain on the affected side or any heed- ache. ‘Monitor vital signs 2, Excess bleeding from ste, headache, signs of excess blood loss ‘vide support. When appropriate, advise patient that ‘with healing, he will be suitable to be fitted with a prosthetic device in 4to 6 weeks. Activity 2 1, Mastoiditis 2, It isthe result ofa spreading middle ea infection. ‘The patient's risk was enhanced after not complet- ‘ng the prescribed prescription therapy. 3, If caught early, treatment will include IV antibiotic therapy and a myringotomy. Ifthe infection has progressed, treatment will include IV antibiotic ‘weatment and a simple mastoidectomy. (CHAPTER 14—CARE OF THE PATIENT WITH A. NEUROLOGICAL DISORDER Neuron Activity 1 See Figure 14-1, A, inthe text, Activity 2 Dendrite: receives impulses 1. Cail body: surounded by cytoplasm 6 Nucleus: par of the cell body 4. Axon: conducts impulses away ftom the neuron cell body Schwann cell produces myetin Myelin sheath: covers neuron fibers and increases te rate of transmission of impulses; protects and insulates the bers & Node of Ranvier: layers of myelin that wrap axons ‘Synaptic knobs: nerve impulses are ransmited ‘through the action of a neurotransmitter Mosby its ad tive ites © 2006, 2003, 1999, 1995, 1991 by Moby ne Christensen: Adult Health Nursing, Sth Edition Study Guide Answer Key Nervous System Activity 1 See Figure 14-2n the text Activity 2 Part Funetion Cerebrum | Interprets sensory messages such as pai, light touch, and pressure; plays A vita role inthe control ofthe body ‘temperature, fluid balance, appetite, ‘and emotions; influences the heart beat, contraction and relaxation of the walls of the blood vessels, hormone secretions, and other vital body function. Brainstem | Carries all nerve fibers between the spinal cord and the cerebrum. Cerebellum | Responsible for coordination of ‘voluntary muscles; maintenance of balance, equilibrium, and muscle tone. ‘Spinal cord | Conducts impulses to and from the Drain; serves asa center for reflex action. Peripheral _ | Transmit sensory information to the nerves spinal cord through afferent neurons, and motor information from the CNS to the various areas of the body ‘through efferent neurons. Cranial nerves conduct impulses between the head, neck, end brain, excluding the ‘vagus nerve, which also serves organs in the thoracic and abdominal cavities. Cranial Nerves uD n B m G wT i vc va J vi. E mK A me x. oH ML F Terms Sentences will vary according to each learner's sentence ‘construction. Ensure that each sentence has a clear expres- sion ofthe term so & patient could understand. a7 Aggnosia: total or partial loss ofthe ability to ree~ ognize familiar objects or persons through sensory stimuli asa result of organic brain damage ‘Aneurysm: dilation of the wall ofa blood vessel ‘usually caused by atherosclerosis and hypertension ‘Apbasia: abnormal neurological condition in which language function is defective or absent because of an injury tothe cerebral cortex ‘Apraxia: impairment inthe ability to perform pur- ‘osefil acts orto use objects properly ‘Ataxia: a genetic disorder characterized by neu- rological problems, particularly abnormalities of balance ‘Aura: defined as a sensation, such as light or ‘warmth that may precede an attack of migraine or epileptic seizure Bradykinesia: slowing down inthe initiation end execution of movement Diplopia: double vision Dysarthria: dificult, poorly articulated speech that usually results from interference inthe control over the mustes of speech Dysphagia: severe swallowing difficulty Flaccid: weak, soft, and flabby and lacking normal muscle tone Glasgow coms scale: quick and practical standard- ined system for assessment of impaired conscious- ness in the critically ill patient and for predicting the uration and ultimate outcome of coma Global cognitive dysfunction: generalized impair- ‘ment of intellect, awareness, and judgment Hemiamopia: characterized by defective vision or blindness in balf of the visual field Hemiplegia: palyss of one side ofthe body Hyperreffexia: neurological condition characterized by increased reflex action ‘Nystagmus; Involuntary, rhythmic movements of the eye Paresis: a lesser degree of movement deficit from ‘arial or incomplete paralysis Postical period: a rest period of variable length after a seizure Proprioceptoa: sensation pertaining to spatal-posi- tion and muscular-sctvity stimuli originating from within the body Spastic: involuntary, sudden movemeat o muscular contraction. ‘Unilateral neglect: condition io which an individual is perceptuslly unaware of and inattentive to oe side of the body Aging ‘Brain weight: loss of brain weight and substantial Joss of neurons (1% a year after age 50) ‘Moby ems and derived items ©2006, 2003, 199, 1995, 1991 ky Mosby Ine, Christensen: Adult Health Nursing, 5th Editon Answer Key + Seucnral changes: decline in iterconnections of decekies, a eduction in cerebral blood flow, and a decrease in brain mecabolism end oxygen utilization + Neqon changes: may contain senile plaques, neu roGbrillary tangles, and the age pigment lipofuscin, ‘Abared sleep’ wakefulness ratio, decrease in ability to regulate body temperature, and decrease in the velocity of nerve impulses. + Body function changes: no functional deterioration of the nervous system Diagnostic Tests L é 1. 8 9. woMmOm mE 10. Glasgow Coma Scale Response ‘Score Eyes Open Spontaneously [To speech Tnappropriate words Tncomprehensible sounds Nowe ‘Motor | Obeys commands Localizes pain Flexion to pain Extension o pain None (eal Neurological Response to Trauma See Figure 148 in the text. Prevention Modifying lifestyles can prevent neurological problems. Avoidance of cigarette smoking decreases lung cancer, 48 ‘which usually metastasizes to the brain, Avoidance of drug end aloobol use. Safe use of motor vehicles. Safe swimming practices. Safe handling and storage of fire- arms, Use of hardbats in dangerous construction areas. Use of protective padding as needed for sport. Intracranial Pressure (ICP) 1. Pupil changes occur due to compression of cranial nerve II (oculomotor) 2. Diplopia ~results from paralysis or weakness of ‘one of the muscles thet controls eye movement 3. Headache results from venous congestion and tea sion inthe intracranial blood vessels asthe cerebral pressure rises 4, Changes in blood pressure — herniation causes ischemia ofthe vasomotor center, which excites the ‘vasoconstrictor fibers, causing the systolic blood pressure to rise 5. Vomiting and singultus~ caused by compression of the vagus nerve Seizures 1, Classified according to the various feaures of the attack 2, The primary types are tonic-clonic (grand mal), absence (petit mal), psychomotor (automatism), jacksonian (focal) and miscellaneous other seizures 3. The transitory disturbance in consciousness or in motor, sensory, or autonomic function with or with cout ass of consciousness 4, Hypoglycemia, infection, electrolyte imbalance, sleobol, arbitrate withdrawal, and water intoxica- ton 5. Aura the premonitory phase; this is experienced by many patients. The actual manifestations may differ. Some patients may report numbness, tingling, ‘visual, olfactory, auditory, or taste hallucinations, Seizure ~ the actual period of seizure activity Postical~ after the seizure; during this time the patient feels groggy and appears disoriented 6. Status epilepticus occurs when generalized, recut- rent seizure activities occur continuously. The patient never regains full consciousness between episodes. Ths is a medical emergency. The activity causes prolonged hypoxia and exhaustion, 7. The patient must be protected from injury. Medica- tions are given to stop the injury. Intubation and ‘venlatry support may be needed. EEG 9. Protection fom aspiration Protection from injury ‘Observation and recording ofthe seizure activity ‘Monby ites and dived tema © 2006, 2003, 199, 195,191 by Mosh I. Christensen: Adult Health Nursing, Sth Edtion Study Guide Answer Key 10. ‘Remain withthe patient If patient is standing, lower the patent tothe floor Support and protect the bead 1 possible, tur the head tothe side to maintain the airway Loosen the clothing around the neck Stroke Mechanism of Injury: blood vessels of the brain characterized by hemorrhage into the brain oF the formation of an embolus or thrombus that occludes an artery, resulting in ischemia of the brain tissue normally perfused by the damaged vessels, Medical Management: if due to an aneurysia, surgery may be needed to remove the clot and to prevent rebleeding, Thrombolytic drugs may be used if ischemia is due to embolus. Fluids may be restricted the fist few days to prevent edema of the ‘rain, Bed rest will be determined by what residual damage there isto the brain. ‘Nursing Interventions: ‘Acute care: care is directed toward survival needs of the patient. Neurological checks at regular intervals for assessment of condition and changes in condi- tion, Nutrition management either with feeding tubes, IV, or assisting wit eating because of dys- phagia. Self-care support. Rehabilitation care: Maintain skin integrity by turning and placement of urinary catheter, Bs- {ablishment of normal bowel function, Effective cominunication through picture card. Prevention of contractures and maintenance of muscle function. Provide reorientation to suroundings frequently. Spinal Cord Trauma 1 ‘Accomplete cord injury occurs when the cord is completely severed. Al voluntary movement below the area of injury is lost. An incomplete injury is partial transaction or injury of the cord. ‘Quadriplegia results with injuries tothe cervical area of the cord, This will affect ll four extremities Paraplegics have injuries tothe thorace, lumbar, oF sacral segments ofthe cord, Spinal shock Arefiexia 11 occurs in patients with cod injuries atthe sixth thoracic vertebra or higher, Iti a condition if increased reflex actions. t occurs as a result of abnormal cardiovascular responses to stimulation of the sympathetic division of the autonomic nervous system, ‘Signs and symptoms include bradycardia, hyperten sion, diaphoresis, gooseflcsh, severe headache, and nasal stufiness. "9 8, Bladder distension, fecel impaction, tight clothing, ingrown toenails, among others 9. Skin breakdown Blood clots Depression ‘Trigeminal neuralgia and Bell's palsy Both involve the cranial nerves, Trigeminal neural- sin afocts cranial nerve V (igeminl) and Bell's palsy affects cranial nerve VII fcil). The exact causes of each are unknown. Bell's palsy is thought to bea possible reactivation ofa herpes simplex vinss Facial pain may occur in both conditions, The discomfort associated with trigeminal neuralgia is significantly more severe. Patients with Bell's palsy ay also experience a loss of tate, reduction of saliva ringing in ears, or bearing loss. Management of Bll’s palsy focuses on support of ‘symptoms to promote comfort, The episode will the majority of cases, run its course. Most patients fully recover. Antiviral medications may be given. Pain managements a primary gol for trigeminal neuralgia. Many paticats will experience facial sensitivity permanently. Surgical intervention may beneeded. Multiple Choice aa 24 S01 4135 Critical Thinking Activities Activity 1 1, Migraine headaches 2, Te numbness and tingling in her bands is an aura to the onset ofthe headaches. Many migraine head ache sufferers report auras. Auras may be auditory, olfactory, o vista. 3, Foods containing tyramine, nitrates, or glutamates should be avoided. Other substances tat should be ‘voided include vinegar, chocolate, yogurt alcohol, fermented or marinsted foods, ripened cheese, cured sandwich mest, caffeine, and pork. 4, Acetylsalcyic acid (aspirin), ergotamine tartrate preparations, end triptans ‘Nonopioid analgesics, and intranasal lidocaine 5, Stress management, pressure applied tothe tepo- ral arteries, quiet environment, and cold packs to the head Activity 2 1, Transient ischemic atack (TTA) ‘Mosby items and derived tert © 2006, 2003, 199, 1995, 191 by Mosby Ine. Christensen: Adult Health Nursing, Sth Edition Study Guide Answer Key 2. Yes, TAs are significant because a least one in three people who experience them will experience a ‘cerebrovascular accident within 2 to 5 years, 3. Carotid Doppler studies ‘CHAPTER 15—CARE OF THE PATIENT WITH AN IMMUNE DISORDER Terms Sentences will vary according to each learner's sentence construction. Ensure that each sentence bas a clear expres- sion ofthe term so a patient could understand. Organization of the Immune System See Figure 15-2 in the textbook. ‘Types of Immunity 1. By activation of T cells 2. ‘They are released indefinitely into the blood and body tissues, 3. Immunity against pathogens that survive inside of cells, fungal infections, rejection of transplanted. tissues, contact hypersensitivity reactions, tumor immunity, and certain autoimmune diseases 4 Bealls ‘Active 6. Inactive immunity the antibodies are produced by the individual. Antibodies produced by another source and given to patients en example of pas- sive immunity 7. Bealls 8. Histamine is released 9. Bacteria and foreign tissue Immunity Natural Immunity + Purpose: To provide physical and chemical barri- cers to invading pathogens and protect against the ‘extemal environment. + Pathophysiology: Innate system is composed of the skin and mucous membranes, cil, stomach acid, tears, saliva, sebaceous glands, and secretions and flora ofthe intestine and vagina, These organs, tis ‘sues, and secretions provide biochemical and physi- cal barriers to disease, ‘Acquired Immunity ‘Purpose: The body's secondary ine of defense agains disease. Provides a specific reaction to cach invading antigen and has the unique ability to remember the antigen, + Pathophysiology: This specific immunity results from the production of antibotes inthe cells. An- tibodies develop naturally ater infection oe arafi- cially after vaccinations, Immunity Differences + Immunocontpetency isthe ability ofthe immune system to make antibodies and respond to an ants gen such as bacteria, + Immmunodeficieney means that there isan altered and failed immune response, + Autoimmunity isthe ability to develop an immune response and build antibodies. Hypersensitivity Development 1. Hypersensitivity disorders arise when harmless sub~ stances are recognized as foreign, These substances include pollens, danders, foods, and chemicals, 2, Exposure may take place by inhalation, ingestion, injection, or contact, 3, Integumentary, gastrointestinal, respiratory, and cardiovascular 4, Patient history and physical examination 5, Host response to allergen, exposure amount, nature of the allergen, route of allengen entry, repeated exposure 6. Risk fr injury, related to exposure to allergen; ‘Activity intolerance, related to malaise; and Risk or infection, related to inflammation of protective ‘mucous membranes Anaphylaxis 1, Respiratory: dyspnea, wheezing, decreased breath sounds 2 Circulatory: dysrhythmias, tachycardia, hypotension 3. Urinary: decreased urine ourput 4, Neurological: mental confusion, anxiety, malaise, coma ‘Treatment: 0,05 epinephrine 1:100 given subcutane- ‘ously. Repeat in 1Sinute intervals a ordered. Benadryl 50-100 mg may be given IM or TV as indi- cated. IV therapy to prevent vascular collapse; patient may be intubated to prevent airway obstruc~ tion. Oxygen by mask may be ondered. “Aminophy/line may be given for bronchospasm, ‘Transfusion Reaction + Selection of blood donors: Careful selection is import became hyper dar may Mpg and crom-maching: mt be nena ‘Storage of blood: important, along with administra tion protocel. Blood components must be refriger- ated at specific temperatures until our before ‘Mosby items end dcived tena © 2006, 2013, 1999, 1995, 1991 by Many ne, CChvistensen: Adult Health Nursing, Sth Edition Study Guide Answer Key administration. Blood mas be given within 4 hours of reigeration. + Administration of blood: Donor and recipient num- ‘pers are specific and must be thoroughly checked. ‘The numbers on the bag are checked with the patient's armband. Autoimmune Disorders ‘Autoimmune disorders are failures ofthe tolerance of “self” They may be described as an immune atack on the self and result from the failure to distinguish “self” pro- tein form “foreign” protein, Plasmapheresis isthe removal cof plasma containing componcats causing or thought to cause disease, This procedure removes pathologie sub- stances (“selP” or autoantibodies) in the plasma, thus re- ducing the immune response, Immunodeficiency Disease First evidence: an increased susceptibility to infec tion, because of the immune system not being able to adequately protect the bod. + Result of immunodeficient state: the immunodefi- cient state involves an impairment of one or more {immune mechanisms, which include phagocytosis humoral response, cel-mediated response, comple- ‘ment anda combined bumoral and cell-mediated deficiency. + ‘Tworypes: primary immunodeficiency and second- ary immunodeficiency disorder. + Factors that alter immune respanse:stres; hypo- finetinal state ofthe immune system; malnutiton; ‘znd radiation or surgical removal of lymph nodes, ‘thymus, or spleen, Multiple Choice ae 2 4 3.1234, 42 Critical Thinking Activities Activity 1 1. The patient should be monitored after the allergy shot This monitoring should include observation for adverse reactions and take place for atleast 20 minutes. 2, The patient should be taught signs and symptoms to Took for regarding hypersensitivity reactions. The patient should have an epineptrine pen on band at home, 3, The physician should be notified. Interupted doses ‘put the patient at risk for hypersensitive reactions, 31 Activity 2 1, Ase normal part of aging, a persen's immune system will often weaken, The risk of inflame tion and infection increases with age. Skin becomes ‘more fagile and may allow pathogens to enter. Infection in most body systems also increases due to a reduction of activity and of secretion mobility and production. ‘Aging often brings on diseases and disorders of several body systems. These may further complicate the patient's health status, ‘Since the potent has demonstrated an increase in iloess, preventive messures should be discussed. The importance of hand washing, avoiding poten- tially harmful situation, and the need for yearly fu shots should be addressed. ‘The signs of early illness may be subtle, To best counteract iliness, early intervention is key. Patients ae advised to contact their health care providers when illness occurs. (CHAPTER 16—CARE OF THE PATIENT WITH HIV/AIDS Terms + Acquired immunodeficiency syadrome (AID: ‘unigue condition characterized by a breakdown in the body's immune system + Adberence: vigilance with treatment + CDéb lymphocyte: laboratory measures concerning the effect ofthe virus on the immune system + Centers for Disease Control and Prevention: agency of the US. government that provides facies and services for investigation, identification, contol, and prevention of diseases + Bozjme linked immunoabsorbent assay (ELISA): ‘rapid enzyme immunochemical assay method to detect certain bacterial antigens and antibodies + HIV disease: broad dingnostic term that includes the pathologic conition and clinical illness caused by HIV infection + HiViinfection: state in which HIV enters the body under favorable conditions and multiplies, produc ing injurious effects + Hluman immunodeficiency virus a retrovirus that ‘causes HIV ingection and HIV disease. + Kaposi's sarcoma: rare cancer of the skin and rmu- ‘cous membrane characterized by blue, red, or purple raised lesions + Opportunistic: caused by normally nonpathogenic ‘organisms in the host whose resistance has been decreased by such disorders as HIV disease Mody ites and derived ema © 2008, 2013, 199,195, 1991 by Mody Is. Christensen: Adult Health Nursing, Sth Edition Study Guide Answer Key + Phagocytic: ingestion and digestion of bacteria + Pneumocystis carinii pneumonia (PCP): unusual pulmonary disease caused by fungus and primarily associated with people who have suppressed im- ‘mune systems + Retrovirus: a member of the lentivirus slow vis) family + Seroconversion: development of detectable level of HIV antibodies found inthe blood + Seronegative: absence of antibodies to HIV + Vertical transmission: transmission from a mother to ‘fetus + Viral load: amount of measurable HIV virions + Virulent: toxic + Western blot test: technique for analyzing small ‘amounts of antibodies Cause of HIV HIV is a retrovirus that causes HIV infection and HIV disease, The CDC's definition given in January 1993 in- ‘eludes additonal clinical conditions, HIV antibody test results, and laboratory measures concerning the effect of ‘the virus on the immune system. It inclues all HTV-in- fected persons who have CDe+ counts of 200 cells/mm? or fewer. HIV disease isthe broad diagnostic term that includes the pathologic condition and clinica ilinss caused by HIV infection HIV infection isthe state in which HIV enters the body under favorable conditions and multiplies, producing in- jurious effects and a unique condition characterized by a breakdown in the body's immune sytem, “Nurse's roe in the prevention of HIV discase is education {in prevention as the onl truly effective vaccine available to curb the HIV infection. [Nurses should assess each patient's isk and how tore= ce or eliminate the risk. Teach patients methods to reduce the risk of transmission. Discuss the details of be- havior relating to seul activity a use in a rte right relaxed, and nonintgenntal manne, Fai rape por here asking sensitive, expt questions Rrsourage patints to use protective Bree Last S08 of the tg, ‘which, alos not el, til rests ina rove nak af TV transmission, Viral Load in the Blood ‘Activity 1 See Figure 161 in the txt, ‘Activity 2 1. Aseries of interrelated factors affects motidity and rortlty of HIV disease. These fctors inti lows er socioeconomic sats, lack of access of acequtte care availabilty of a hospital with experience in cating for patients with HIV disease, ‘Three pattems have been identified: 1. Typical progressors accounts for 80-90 % of pationts 2, —_Longeter progressos remain symptorftee for up to 10 year; this nocounts foe 9% of patients 3, Rapid progressors advance toa cagnosis of fullblown AIDS within 2-3 years; counts for $-10% of patient Seroconversion takes place § days to 3 months afer exposure in most individuals, 4. Vague signs and syrmptoms similar toa viral illness say result. These incl fatigue, headaches, lows grade fever, and night sweats, ‘The later the diagmosis is, the Iter the onset of dg therapy willbe, Drug therapy initiated sooner bas & positive impact onthe course ofthe illness. Viral set point (viral stabilization is an inion- tor of long-term survival. The lower the setpoint, the longer the patient can be expected to live after exposure. ‘Mos item and dative tems © 206,203, 1999, 1995, 1991 by Mody Io, Christensen: Adult Health Nursing, Sth Editon Study Guide Answer Key Diagnostic Tests a Diagnostic Test Tmltony ad Proce HIV antibody testing | 1, HIV positive. Deeds the presence of he HIV anton, Iyer the Nova ste see tne If postive, then the Wester blot testis done. If owitive (all thee, patie ate reported 12. Ifindeterminate results, the person i texted apa in 46 weeks, Ic nate results then a viral culture is done. 3, The series of laboratory tests confirms the pretence of the anitwites to LIV at does not sean the person bas AIDS. AIDS 4, Seronegative testis not an assurance that the inlvidual is fe of IHIV inteation, because seroconversion may not have occured yet, 5, Seronegative test does not mean that the icv is fee ofthe rink af infection, UF risky ‘ebaviors continue, the patient fon iteternie ingroned according tthe 199% deisiion by CDC, acquire the infection, enne ad inthe best raket fw tho wunnlefsied> Cer cell ‘Used to monitor the progression of HI monitoring cy associated with HIV infection, Itmeasures the numberof C1), ces por ewe aniimetet ot per microliter of blood. Thus, the CD,* count is a marker ofthe net evel of ell represented per mm?. It is advised to draw two separate samples a few weeks apart, Viral load THIV viral load measurement refers to a quantitative measure of 1HIV vit RNA Un the peviper~ ‘monitoring 21 Blood or the evel of virus in the blood. The indicates the vet point at an adequate rector ‘of long-term progression ofthe virus. Measurement of CD cells meanurenents can invate ‘the damage sustained by the immune system and the short-term ak for developing opportunity tic infections. A baseline is determined with repeat testing every 4-4 months ‘CBC Decreased count i often seen in conjunction with fymapopenia, Anemia revuls thom brome disease process to HIV invasion ofthe bone narrow, and in «common advert effect of ently retroviral, a u iver function is not uncommon for HIV-pos 10 ale be postive for hepatii B, Syphilis ‘Syphilis is more complicated and aggressive in HIV-infected indivutun Risk for HIV + Limit number of pater © Use protective measures nicht ax eondoray, and put Activity 1 thom om ax woo a the eretion ecu Pationts at Risk + Unethe condom correct, apace athe tp, only ‘Drug users, directly or indirectly, with injection drug use (using HIV-conteminated needles to inject

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