Exhibits

Select the 2 findings that indicate the client's condition is improving.

A. Occupational therapist: An occupational therapist helps clients regain skills for daily living, such as dressing and grooming. They are not primarily involved in managing nutritional concerns like decreased weight or prealbumin levels.

B. Physical therapist: A physical therapist focuses on mobility, strength, and balance. While essential in stroke recovery, they are not directly responsible for addressing nutritional issues such as decreased weight or prealbumin.

C. Dietitian: A dietitian is the most appropriate team member for managing the client’s decreased weight and prealbumin. They assess nutritional needs and develop plans to address deficiencies, ensuring the client gets adequate nutrition.

D. Respiratory therapist: A respiratory therapist manages breathing and oxygenation. They are not directly involved in addressing nutritional issues such as weight loss or prealbumin levels.

Rationale for Correct Choices:

• Infection: A low WBC count of 4,100/mm³ indicates a suppressed immune system, which is a complication in HIV. White blood cells play a key role in fighting infections, so a drop below the normal range places the client at increased risk for opportunistic and routine infections.
• WBC count: The client's WBC count has declined from 4,500/mm³ at diagnosis to 4,100/mm³, now falling below the standard range of 5,000–10,000/mm³. This trend suggests worsening immunosuppression, commonly seen in clients with HIV as the virus affects CD4+ T cells, reducing the body’s ability to fight infections.

Rationale for Incorrect Choices:

• Seizures: Seizure risk is usually associated with electrolyte imbalances, especially hyponatremia or hypernatremia. The client’s sodium level is 139 mEq/L, which is within the normal range, indicating that the risk for seizures is not elevated.
• Bleeding: Although the client’s platelet count has slightly decreased from 164,000 to 162,000/mm³, it remains within the normal range of 150,000–400,000/mm³. Significant bleeding risk generally arises when platelet levels fall well below 100,000/mm³.
• Dysrhythmias: The potassium level is 3.8 mEq/L, within the normal range of 3.5–5.0 mEq/L. Abnormal potassium levels, particularly hypo- or hyperkalemia, are key contributors to cardiac dysrhythmias, which are not suggested by the current lab values.
• Renal failure: The client’s BUN is 18 mg/dL, well within the normal range of 10–20 mg/dL. There is no elevation in BUN or signs of impaired kidney function, making renal failure an unlikely concern at this time.
• Platelet count: The platelet count is slightly lower than before but still within normal limits. A count of 162,000/mm³ does not pose a clinical concern for bleeding, and it does not indicate a serious hematologic issue requiring immediate intervention.
• Sodium level: The sodium level is 139 mEq/L, which is normal. It does not contribute to neurological symptoms such as seizures and is not associated with infection risk or other critical conditions in this scenario.
• Potassium level: The potassium level of 3.8 mEq/L is also within normal range. There is no evidence of potassium-related complications such as dysrhythmias or muscle weakness in the current context.
• BUN level: The client's BUN level is within the normal range (18 mg/dL), indicating normal kidney function and not a risk factor for any of the listed conditions.