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Approach to disorders of na and water balance. Abnormalities can be grouped into disorders of tonicity or ecf volume. The conceptual approach to disorders of tonicity (e.G., hyponatremia) depends on whether the newborn exhibits normal ecf (euvolemia), ecf depletion (dehydration), or ecf excess (edema). A. Lonatremic disorders 1.

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Infection in the newborn occurs as a result of direct exposure, most commonly in the perinatal period from maternal genital disease. Hsv-2 is more likely to recur in the genital tract and, therefore, accounts for most neonatal hsv infections. In one study, the characteristic ulcerations of the genitalia were present only in two-thirds of the genital tracts from which hsv could be isolated. Others had asymptomatic shedding or atypical lesions. It is estimated that up to 0.4% of all women presenting for delivery are shedding virus, and approximately 1% of all women with a history of recurrent hsv infection asymptomatically shed hsv at delivery. However, when the birth canal is carefully visualized and those with asymptomatic lesions infectious diseases i 59 5 excluded, this rate of shedding is nearer to 0.5%. It is critical to recognize that most mothers of infants with neonatal hsv do not have a history of hsv. Approximately 30% to 50% of infants will acquire hsv infection if maternal primary infection occurs near delivery. Whereas

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Continue regimen symptoms that occur during the course of the disease should be treated as they occur. Essential elements in the treatment of ad include education, communication, and planning with the patient’s family/ caregiver. Treatment options, legal and financial decisions, and course of the illness should be discussed with the patient and family members. In this regard, the clinician’s emphasis should be on helping to maintain a therapeutic living environment while minimizing the burden of care resulting from the disease. Nonpharmacologic therapy the life of a patient with ad must become progressively more simple and structured as the disease progresses, and the caregiver must learn to keep requests and demands on the patient simple. Basic principles in the treatment of patients with ad are shown in table 29–4. Pharmacologic therapy »» conventional pharmacologic treatment for cognitive symptoms che inhibitors (donepezil, rivastigmine, and galantamine)  the che inhibitors are fda approved for the treatment of ad. Guidelines recommend the use of che inhibitors as a valuable treatment for ad and the use of memantine for moderate to severe ad.

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10,16,17,37,40 when compared with endometrial ablation, the levonorgestrel iud causes similar reductions in menstrual blood loss after 6, 12, and 24 months. 41 patient care process patient assessment. •• based on physical examination, history, and review of systems, additional work-up may be necessary (eg, amenorrhea, menorrhagia, aub, or pmdd). •• document symptoms. •• conduct a medication history. Have any treatments helped in the past?. •• review the medical history and laboratory data. Does the patient have any complications, such as symptoms of anemia in patients presenting with menorrhagia or difficulty conceiving in women with amenorrhea or anovulatory bleeding?. •• review available diagnostic data to determine hormonal, reproductive, and pregnancy status. Does the patient need a pregnancy test?. Therapy evaluation. •• is current pharmacotherapy safe and effective. Is dosing appropriate?.