By H. Vak. Butler University. 2018.

Individuals with • Differential: measurement of the pro- HIV frequently fear that they will lose portion of each type of white blood their jobs as a result of their diagnosis purchase 20mg tadora visa erectile dysfunction and alcohol, re- cell (i tadora 20 mg with visa impotence used in a sentence. Because infection can ma is normal) have such serious consequences for indi- viduals with HIV infection, they should Other types of blood tests used to meas- also avoid job situations in which they are ure specific components of blood are as likely to be exposed to infection. As the follows: HIV infection progresses and individuals • Reticulocyte count: assessment of bone experience increasing fatigue, they may marrow function by measuring its need to undertake less strenuous work or production of immature red blood arrange for shorter work schedules or cells (reticulocytes) more frequent rest periods. In the later • Platelet count: measurement of the stages of the disease, mental changes may number of platelets in a cubic mil- affect an individual’s capacity to function limeter of blood in the work setting. A complete blood count is a test Bleeding Time Test used to evaluate a number of different com- ponents in the blood. Sometimes these A bleeding time test measures the length various components are also measured of time it takes for bleeding to stop after Diagnostic Procedures for Conditions Affecting the Blood or Immune System 251 a small puncture wound. The test deter- specific part of the clotting mechanism mines how quickly a platelet clot forms. The bone marrow is then examined A prothrombin time test measures the microscopically for various abnormalities length of time that a blood sample takes in the number, size, and shape of the pre- to clot when certain chemicals are added cursors of red blood cells, white blood to it in the laboratory. Pro- ond test is negative, the test result is con- longation of clotting time indicates that sidered negative. If the result of the individuals may be prone to abnormal second test is positive, the Western blot bleeding. If the test indicates that clotting test is usually performed as a confirmato- time is reduced, there may be blood hy- ry test. If the result of the Western blot test percoagulability, which could contribute is positive, it is highly suggestive that the to the formation of blood clots. HIV antibody is present and that the indi- vidual has been exposed to HIV. Partial Thromboplastin Time (PTT) Test Hemoglobin Electrophoresis A partial thromboplastin time test is used to evaluate a special part of the clotting Hemoglobin electrophoresis is a blood mechanism not evaluated by prothrom- test by which a definitive diagnosis of bin time. As with the prothrombin time sickle cell disease or sickle cell trait can be test, certain chemicals are added to a made. Prolongation of time in which it takes a clot to form is indicative of a Sickle cell prep is a blood test used in sick- bleeding disorder, such as that found in le cell screening. Prolongation of clot formation presence of abnormal hemoglobin but can- may also be found with the use of the not distinguish between sickle cell disease anticoagulant heparin, which affects a and sickle cell trait. Bone marrow transplants are ment is directed toward symptoms and/or used when the immune system is severe- the underlying cause. If a blood disorder ly deficient or when certain types of can- is caused by a toxic substance, the first line cers exist (see Chapter 16). Bone marrow of treatment is to remove the offending cells are received from a donor, and a care- agent. Anemia that is caused by a deficien- ful match is made to decrease the chances cy may be treated by supplementation or of rejection of the transplant and to pre- replacement therapy. For instance, iron vent a reaction in which the transplant- deficiency anemia may be treated by the ed cells attack the cells of the individual administration of oral or injectable iron who has received the transplant. When there is an overproduction of red blood cells, as in polycythemia, treatment PSYCHOSOCIAL ISSUES IN may involve the removal of blood. Vene- CONDITIONS AFFECTING THE BLOOD section (phlebotomy) is a procedure in OR IMMUNE SYSTEM which quantities of blood are removed to reduce the volume of blood. Psychological Issues Disorders of the blood and immune sys- Transfusion tem have a variety of psychological impli- cations. The specific implications for a Part of the treatment for a number of particular individual are dependent on the blood disorders may be the transfusion of condition. Some conditions may be con- whole blood or a blood component, such as trolled relatively easily, whereas others re- packed red blood cells, plasma, or plate- quire constant vigilance. Because blood is living tissue, trans- conditions may be treated and, in some in- fusion can be thought of as a form of stances, cured, others require lifelong treat- transplantation, carrying the same risks of ment and carry a more ominous prognosis. For this reason, the exact the blood and immune system generally matching of a number of factors in the have no visible reminders of their disabil- blood between the donor and the re- ity. Without external adaptive devices, cipient is crucial to prevent serious aller- such as wheelchairs, crutches, or canes, or gic reactions, which could be fatal.

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Parents may be overprotective child’s ability to accurately evaluate his or to the point of infantilizing the adoles- her potential purchase tadora 20mg fast delivery depression and erectile dysfunction causes. Encouragement of social cent purchase 20mg tadora fast delivery erectile dysfunction miracle shake, thus decreasing self-esteem and self- interactions and activities to the degree confidence. If adolescents deny the limitations associated with their Perceptions of and interactions with disability or ignore treatment recommenda- peers become increasingly important as tions, there can be further detrimental ef- adolescents further define their identity fects on physical and functional capacity. With the need to establish independence, Chronic Illness or Disability in Young adolescents begin to emancipate them- Adulthood selves from their parents and may rebel against authority in general. Physical In young adulthood, individuals estab- maturation brings about a strong preoccu- lish themselves as productive members of pation with the body and appearance. Awareness tionships, and accepting social responsi- of and experimentation with sexual feel- bility. When a chronic illness or disability ings present a new dimension with which develops, its associated limitations, rather the adolescent must learn to cope. Dating than the individual’s interests or abilities, and expression of sexuality are important may define his or her social, vocational, aspects of maturation. Chronic Illness and Disability Through the Life Cycle 11 Physical limitations may also inhibit being of individuals and their families, as individuals’ efforts to build intimate rela- well as on their identity, self-concept, and tionships or to maintain the relationships self-esteem. At this established roles and associated responsi- developmental stage, established relation- bilities within the family. At the same ships are likely to be recent, and the lev- time, individuals’ partners, even when the el of commitment and willingness to make relationship is long term, may be reeval- necessary sacrifices may vary. They may per- on the nature of the condition, procre- ceive chronic illness or disability as a ation may be difficult or impossible, or, if violation of their own well-being, and the individual already has young children, they may choose to leave the relationship. In some cases the family’s Ideally, older adults have adapted to the overprotectiveness may prevent them triumphs and disappointments of life and from having experiences appropriate to have accepted their own life and immi- their own age group. Although physical limitations associated with normal aging are variable, Chronic Illness or Disability in older adults often experience diminished Middle Age physical strength and stamina, as well as losses of visual and hearing acuity. Illness Individuals in middle age are generally or disability during older adulthood can established in their career, have a commit- pose physical or cognitive limitations in ted relationship, and are often providing addition to those due to aging. The spouse guidance to their own children as they or significant others of the same age group leave the family to establish their own may also have decreased physical stami- careers and families. At the same time, na, making physical care of individuals middle-aged individuals may be assuming with chronic illness or disability more dif- greater responsibility for their own elder- ficult. When older adults with chronic ill- ly parents, who may be becoming increas- ness or disability are unable to attend to ingly fragile and dependent. During their own needs or when care in the home middle age, individuals may begin to is unmanageable, they may find it neces- reassess their goals and relationships as sary to surrender their own lifestyle and they begin to recognize their own mortal- move to another environment for care and ity and limited remaining time. Many individuals in the older Illness or disability during middle age age group live on a fixed retirement in- can interfere with further occupational come, and the additional expenses associ- development and may even result in ear- ated with chronic illness or disability place ly retirement. Such changes can have a significant strain on an already tight bud- significant impact on the economic well- get. Not all older individuals, of course, have 12 CHAPTER 1 PSYCHOSOCIAL AND FUNCTIONAL ASPECTS OF CHRONIC ILLNESS AND DISABILITY retirement benefits, savings, or other re- which is also determined by social and sources to draw on in time of financial need. OTHER ISSUES IN CHRONIC Chronic illness or disability forces an ILLNESS AND DISABILITY individual to alter his or her self-image to accommodate associated changes. Factors Self-Concept and Self-Esteem influencing the degree of alteration include: • the visibility of change Self-concept is tied to self-esteem and per- • the functional significance of the sonal identity. It can be defined as individ- change uals’ perceptions and beliefs about their • the speed with which change occurred own strengths and weaknesses, as well as • the importance of physical change or others’ perceptions of them. Self-esteem associated functional limitations to can be defined as “the evaluative compo- the individual reactions of others nent of an individual’s self concept” (Moore et al. It is often thought of as the assessment of one’s own self- The degree to which an altered self- worth with regard to attained qualities image is perceived by the individual in a and performance (Gledhill et al. A negative and success or failure in the workplace self-concept can produce negative re- (Cusack, 2000). Consequently, self-concept has a ment is not always proportional to the significant impact on interactions with reaction it provokes. Change considered others and on the psychological well- minimal by one individual may be con- being of the individual. Changes do not have to be visible in or- Body Image der to alter body image. Burn scars on parts of the body normally covered by Body image, an important part of self- clothing or the introduction of an artifi- concept, involves individuals’ mental view cial opening or stoma such as with colo- of their body with regard to appearance stomy may cause significant alteration in and ability to perform various physical body image even though physical changes tasks.

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These sinuses are responsible ditory (eustachian) tubes connect the nasopharynx with for some sound resonance purchase tadora 20 mg overnight delivery erectile dysfunction queensland, but most important tadora 20 mg sale erectile dysfunction pump demonstration, they function to the tympanic cavities. The pharyngeal tonsils, or ade- decrease the weight of the skull while providing structural noids, are situated in the posterior wall of the nasal cavity. During the act of swallowing, the soft palate and uvula You can observe your own paranasal sinuses. Face a mirror are elevated to block the nasal cavity and prevent food from in a darkened room and shine a small flashlight into your entering. The frontal sinuses will be illuminated by directing the light just below the eyebrow. The maxillary sinuses are illuminated by shining the light into the oral cavity and closing your mouth around the flashlight. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 608 Unit 6 Maintenance of the Body FIGURE 17. The larynx has two func- occurs before the uvula effectively blocks the nasopharynx, tions. Its primary function is to prevent food or fluid from entering fluid will be discharged through the nasal cavity. Both Laryngitis is the inflammation of the mucosal epithelium of the swallowed food and fluid and inhaled air pass through it. Laryngitis may result from overuse of the voice, inhalation of an irritating chemical, or oropharynx. Paired palatine tonsils are located on the pos- a bacterial or viral infection. Mild cases are temporary and seldom of terior lateral wall, and the lingual tonsils are found on the major concern. It extends inferiorly from the level large unpaired structures, and six are smaller and paired. The of the hyoid bone to the larynx and opens into the esopha- largest of the unpaired cartilages is the anterior thyroid cartilage. It is at the lower laryngopharynx that the The laryngeal prominence of the thyroid cartilage is commonly respiratory and digestive systems become distinct. Tonsils are lymphoid organs and tend to be- come swollen and inflamed after persistent infections. The removal of the palatine epiglottis is located behind the root of the tongue where it aids tonsils is called a tonsillectomy, whereas the removal of the pharyn- in closing the glottis, or laryngeal opening, during swallowing. The entire larynx elevates during swallowing to close the glot- tis against the epiglottis. This movement can be noted by cup- Larynx ping the fingers lightly over the larynx and then swallowing. In this case, the abdominal thrust ducting division that connects the laryngopharynx with the trachea. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 17 Respiratory System 609 Posterior Base of tongue Vestibular folds Vocal folds Cuneiform Corniculate cartilage cartilage Anterior (a) Posterior Epiglottis Glottis Inner lining of trachea (c) Anterior (b) FIGURE 17. In (a) the vocal folds are taut; in (b) they are relaxed and the glottis is opened. This third unpaired cartilage connects glottis during swallowing and in speech. There are two groups of la- the thyroid cartilage above and the trachea below. The other paired cuneiform cartilages and corniculate pitches are produced as air passes over the altered vocal folds. Mature males Two pairs of strong connective tissue bands are stretched generally have thicker and longer vocal folds than females; therefore, across the upper opening of the larynx from the thyroid cartilage the vocal folds of males vibrate more slowly and produce lower anteriorly to the paired arytenoid cartilages posteriorly. The loudness of vocal sound is determined by the force of the vocal folds (true vocal cords) and the vestibular folds (false the air passed over the vocal folds and the amount of vibration. The vestibular folds support the vocal vocal folds do not vibrate when a person whispers. The vestibular folds are not essary to convert sound into recognizable speech. Vowel sounds, used in sound production, but rather the vocal folds vibrate to for example, are produced by constriction of the walls of the phar- produce sound. The pharynx, paranasal sinuses, and oral and nasal cavities folds, whereas the rest of the larynx is lined with pseudostratified act as resonating chambers.

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Because articular cartilage lacks blood vessels cheap tadora 20mg otc erectile dysfunction drugs with the least side effects, it has of their structure and the motion they permit generic tadora 20mg fast delivery erectile dysfunction medication for sale. The six categories to be nourished by the movement of synovial fluid during joint are gliding, hinge, pivot, condyloid, saddle, and ball-and-socket. Composed of dense regular connective tissue, ligaments are flexible cords that connect from bone to bone as they help bind Gliding synovial joints. Ligaments may be located within the joint cavity Gliding joints allow only side-to-side and back-and-forth move- or on the outside of the joint capsule. The articulating surfaces are nearly flat, or one the knee joint,where they cushion and guide the articulating may be slightly concave and the other slightly convex (fig. A few other synovial joints,such as the temporomandibu- The intercarpal and intertarsal joints, the sternoclavicular joint, lar joint (see fig. Many people are concerned about the cracking sounds they hear as joints move, or the popping sounds that result from Hinge “popping” or “cracking” the knuckles by forcefully pulling on the fin- Hinge joints are monaxial—like the hinge of a door, they permit gers. When a synovial joint is pulled upon, its volume is suddenly expanded and the pressure of movement in only one plane. In this type of articulation, the sur- the joint fluid is lowered, causing a partial vacuum within the joint. As face of one bone is always concave, and the other convex the joint fluid is displaced and hits against the articular cartilage, air (fig. Hinge joints are the most common type of synovial bubbles burst and a popping or cracking sound is heard. Examples include the knee, the humeroulnar articulation displaced water in a sealed vacuum tube makes this sound as it hits against the glass wall. Popping your knuckles does not cause arthri- within the elbow, and the joints between the phalanges. Pivot The articular cartilage that caps the articular surface of each bone and the synovial fluid that circulates through the joint The movement at a pivot joint is limited to rotation about a cen- during movement are protective features of synovial joints. In this type of articulation, the articular surface on one serve to minimize friction and cushion the articulating bones. Should trauma or disease render either of them nonfunctional, the two articu- bone is conical or rounded and fits into a depression on another lating bones will come in contact. Examples are the proximal articulation of the type of arthritis will develop within the joint. These closed sacs are com- monly located between muscles, or in areas where a tendon Condyloid passes over a bone. They function to cushion certain muscles and A condyloid articulation is structured so that an oval,convex ar- assist the movement of tendons or muscles over bony or ligamen- ticular surface of one bone fits into a concave depression on an- tous surfaces. This permits angular movement in two surrounds and lubricates the tendons of certain muscles, particu- directions,as in up-and-down and side-to-side motions. The radiocarpal joint of the wrist and the metacarpophalangeal joints are examples. Improperly fitted shoes or inappropriate shoes can cause joint related problems. People who perpetually wear high-heeled shoes often have backaches and leg aches because their posture Saddle has to counteract the forward tilt of their bodies when standing or walking. Their knees are excessively flexed, and their spine is thrust Each articular process of a saddle joint has a concave surface in forward at the lumbar curvature in order to maintain balance. This articulation fitted shoes, especially those with pointed toes, may result in the de- is a modified condyloid joint that allows a wide range of move- velopment of hallux valgus—a lateral deviation of the hallux (great toe) ment. One is at the articulation of the trapezium of the carpus with the first metacarpal bone (fig. Articulations © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 8 Articulations 203 FIGURE 8. Bursae are commonly located between muscles or between tendons and joint capsules. The most frequent type of joint injury is a sprain, in which the supporting ligaments or the joint capsule are Ball-and-Socket damaged to varying degrees. Ball-and-socket joints are formed by the articulation of a rounded convex surface with a cuplike cavity (fig. This Knowledge Check multiaxial type of articulation provides the greatest range of movement of all the synovial joints. List the structures of a synovial joint and explain the func- humeral (shoulder) and coxal (hip) joints.

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