These interventions contribute to adequate fluid intake. The manifestations of viral, fungal, and bacterial infections are similar, and appearance is not diagnostic except when the white, irregular patches on the oropharynx suggest that candidiasis is present. COPD ND3: Impaired gas exchange. Medscape Reference. c. TLC: (2) Maximum amount of air lungs can contain The other options do not maintain inflation of the alveoli. Respiratory distress requires immediate medical intervention. So to avoid that, they must be assisted in any activities to help conserve their energy. g) 4. What the oxygenation status is with a stress test 3) Treatment usually includes macrolide antibiotics. There is an induration of only 5 mm at the injection site. 8. a. 4. Medical-surgical nursing: Concepts for interprofessional collaborative care. . Empyema is a collection of pus in the thoracic cavity. Inhalation of toxic fumes/chemical irritants can damage cilia and lung tissue and is a factor in increasing the likelihood of pneumonia. b. Discharge from the hospital is expected if the patient has at least five of the following indicators: temperature 37.7C or less, heart rate 100 beats/minute or less, heart rate 24 breaths/minute or less, systolic blood pressure (SBP) 90 mm Hg or more, oxygen saturation greater than 92%, and ability to maintain oral intake. The nurse identifies a nursing diagnosis of impaired gas exchange for a patient with pneumonia based on which physical assessment findings? b. Nutrition reviews, 68(8), 439458. Community-acquired pneumonia occurs outside of the hospital or facility setting. A tracheostomy is safer to perform in an emergency. Otherwise, scroll down to view this completed care plan. See Table 25.8 for more thorough descriptions of these sounds and their possible etiologies and significance. Adjust the room temperature. (2022, January 26). The home health nurse provides which instruction for a patient being treated for pneumonia? b. 2) Ensure that the home is well ventilated. a. Stridor Use narcotics and sedatives with caution.Narcotics for pain control or anti-anxiety medications should be monitored closely as they can further suppress the respiratory system. A patient develops epistaxis after removal of a nasogastric tube. d. Patient can speak with an attached air source with the cuff inflated. Patients should not use cough suppressants and antihistamines because they are ineffective and may induce coughing episodes. Pleurisy When taking care of a patient with pneumonia, it is important to ensure the environment is well ventilated, conducive for good rest, and accessible when the patient needs assistance or help. During care of a patient with a cuffed tracheostomy, the nurse notes that the tracheostomy tube has an inner cannula. St. Louis, MO: Elsevier. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. The patient will have a big chance to remember how to administer or perform any therapeutic regimen if they are given the chance to demonstrate and have him/her verbalize their understanding about it. Smoking does not directly affect filtration of air, the cough reflex, or reflex bronchoconstriction, but it does impair the respiratory defense mechanism provided by alveolar macrophages. f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted. When does the nurse record the presence of an increased anteroposterior (AP) diameter of the chest? 5) Corticosteroids and bronchodilators are helpful in reducing Fill fluid containers immediately before use (not well in advance). high-pitched and inspiratory crackles (rales) that are amplified by coughing or heard only after coughing. The nurse identifies which factor that places a patient at risk for aspiration pneumonia? Also, they will effectively help spread the disease process since they know the mode of transmission and how to break the cycle of transmitting it to other family members. Because antibody production in response to infection with the tuberculosis (TB) bacillus may not be sufficient to produce a reaction to TB skin testing immediately after infection, 2-step testing is recommended for individuals likely to be tested often, such as health care professionals. c. It has two tubings with one opening just above the cuff. Assisting the patient in moderate-high backrest will facilitate better lung expansion thus they can breathe better and would feel comfortable. Ventilator-associated pneumonia is one of the subtypes of hospital-acquired pneumonia. To regulate the temperature of the environment and make it more comfortable for the patient. i. Sexuality-reproductive d. Initiate pulse oximetry for continuous monitoring of the patient's oxygen status. What action should the nurse take? e. Suction the tracheostomy tube when there is a moist cough or a decreased arterial oxygen saturation by pulse oximetry (SpO2). 2. of . Those at higher risk, such as the very young or old, patients with compromised immune systems, or who already have a respiratory comorbidity, may require inpatient care and treatment. Proper nutrition promotes energy and supports the immune system. Bronchoconstriction Look for and report urine output less than 30 ml/hr or 0.5 ml/kg/hr. These interventions help ensure that the patient has the appropriate knowledge and is able to perform these activities. A) 2, 3, 4, 5, 6 6. A transesophageal puncture https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pneumonia, https://my.clevelandclinic.org/health/diseases/4471-pneumonia, https://doi.org/10.1111/j.1753-4887.2010.00304.x, https://emedicine.medscape.com/article/234753-overview#a4, Hypertension Nursing Diagnosis & Care Plan, The ABCs of Evidence-Based Practice in Nursing, Diminished lung sounds or crackles/rhonchi, Patient will demonstrate appropriate airway clearance techniques, Patient will display improvement in airway clearance as evidenced by clear breath sounds and an even and unlabored respiratory rate, Hypoventilation causing a lack of oxygen delivery, Patient will display appropriate oxygenation through ABGs within normal limits, Patient will demonstrate appropriate actions to promote ventilation and oxygenation, Inadequate primary defenses: decreased ciliary action, respiratory secretions, Invasive procedures: suctioning, intubation, Patient will not develop a secondary infection or sepsis, Patient will display improvement in infection evidenced by vital signs and lab values within normal limits. Skin breakdown allows pathogens to enter the body. Arrange the tasks of the patient when providing care to him/her. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. Promote oral hygiene, including lip and tongue care. c. Send labeled specimen containers to the laboratory. - A nurse should be aware of some of the common side effects of antitubercular drugs like rifampin, one of which is orange discoloration of body fluids such as urine, sweat, tears, and sputum. 2. Shetty, K., & Brusch, J. L. (2021, April 15). Pneumonia is the second most common nosocomial infection in critically ill patients and a leading cause of death from hospital-acquired infections. A) Teaching the patient how to cough effectively and. Decreased or random breath sounds (e.g., crackles, wheezes) may indicate possible respiratory failure, which would further exacerbate hypoxia and require immediate intervention. There is a prominent protrusion of the sternum. b. Cyanosis Assess lung sounds and vital signs.Assess breath sounds, respiratory rate and depth, sp02, blood pressure and heart rate, and capillary refill to monitor for signs of hypoxia and changes in perfusion. 3. Provide factual information about the disease process in a written or verbal form. Support (splint) the surgical wound with hands, pillows, or a folded blanket placed firmly over the incision site. If he or she can not do it, then provide a suction machine always at the bedside. Assess breath sounds, respiratory rate and depth, sp02, blood pressure and heart rate, and capillary refill to monitor for signs of hypoxia and changes in perfusion. Use a sterile catheter for each suctioning procedure. Although inadequately treated -hemolytic streptococcal infections may lead to rheumatic heart disease or glomerulonephritis, antibiotic treatment is not recommended until strep infections are definitely diagnosed with culture or antigen tests. Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention. The patient will most likely feel comfortable and easy to breathe when their head is elevated in bed. A) Use a cool mist humidifier to help with breathing. If he or she cannot do it alone, make sure to place suction secretions at the bedside to use anytime. To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Select all that apply. d. Activity-exercise: Decreased exercise or activity tolerance, dyspnea on rest or exertion, sedentary habits b. Epiglottis Hospital acquired pneumonia may be due to an infected. A 70-year-old patient presents to the emergency department with symptoms that indicate pneumonia. a. A patient who is being treated at home for pneumonia reports fatigue to the home health nurse. Pulmonary function tests are noninvasive. 1. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. Smoking further increases the risk of developing pneumonia and should be avoided. To care for the tracheostomy appropriately, what should the nurse do? b. Bronchophony She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Desired Outcome: At the end of the span of care, the patient will manifest better lung ventilation and improve tissue perfusion, and maximum optimal gas exchange by having normal arterial blood gas results, minimum to no symptoms of respiratory distress, and normal production of mucus in the airway. Promote fluid intake (at least 2.5 L/day in unrestricted patients). Administer nebulizer treatments and other medications.Nebulizer treatments can loosen secretions in the lungs while mucolytics and expectorants can help thin mucus and make it easier to cough up. These interventions help facilitate optimum lung expansion and improve lungs ventilation. Antiviral agents will help reduce the duration and severity of influenza in those at high risk, but immunization is the best control. b. 1. This can lead to hypoxia (lack of oxygen), and possibly tissue damage. d. Comparison of patient's current vital signs with normal vital signs Ventilation-perfusion scans and positron emission tomography (PET) scans involve injections, but no manipulation of the respiratory tract is involved. If O2 saturation does not increase to an acceptable level (greater than 92%), FiO2 is increased in small increments while simultaneously checking O2 saturation or obtaining ABG values. The patient may have a limit to visitors to prevent the transmission of infections. Level of the patient's pain Advised the patient that he or she will be evaluated if he or she can tolerate exercise and develop a special exercise to help his or her recovery. b. The oxygenation status with a stress test would not assist the nurse in caring for the patient now. c. Wheezing Patient with a fever This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Keep skin clean and dry through frequent perineal care or linen changes. Normally the AP diameter should be 13 to 12 the side-to-side diameter. Other bacteria that can cause pneumonia include H. influenzae, Mycoplasma pneumonia, Legionella pneumonia, and Chlamydia pneumoniae. CASE STUDY: Rhinoplasty A) Sit the patient up in bed as tolerated and apply Pulse oximetry is inaccurate if the probe is loose, if there is low perfusion, or when skin color is dark. Normal findings in arterial blood gases (ABGs) in the older adult include a small decrease in PaO2 and arterial oxygen saturation (SaO2) but normal pH and PaCO2. 7) c. Send labeled specimen containers to the laboratory. c. Airway obstruction d. The patient cannot fully expand the lungs because of kyphosis of the spine. d. VC: (4) Maximum amount of air that can be exhaled after maximum inspiration b. With acute bronchitis, clear sputum is often present, although some patients have purulent sputum. Priority: Sleep management The live attenuated influenza vaccine is given intranasally and is recommended for all healthy people between the ages of 2 and 49 years but not for those at increased risk of complications or HCPs. Assess for mental status changes.Poor oxygenation leads to decreased perfusion to the brain resulting in a decreased level of consciousness, restlessness, agitation, and lethargy. a. The patient is positioned and instructed not to talk or cough to avoid damage to the lung. Place or install an air filter in the room to prevent the accumulation of dust inside. Administer analgesics 1/2 hour prior to deep breathing exercises. Volcanic eruptions and other natural events result in air pollution. c. a throat culture or rapid strep antigen test. Productive cough (viral pneumonia may present as dry cough at first). Moisture helps minimize convective moisture loss during oxygen therapy. The turbinates in the nose warm and moisturize inhaled air. b. Unstable hemodynamics Thorough hand hygiene before and after patient contact (even if gloves are worn). b. Repeat the ABGs within an hour to validate the findings. An ET tube has a higher risk of tracheal pressure necrosis. g. FEV1: (1) Amount of air exhaled in first second of forced vital capacity Remove the inner cannula and replace it per institutional guidelines. a. Apex to base d. Normal capillary oxygen-carbon dioxide exchange. 3.6 Risk for imbalanced nutrition: less than body requirements. Refer to a community-based smoking cessation program or offer nicotine replacement therapy as needed. b. What is the most appropriate action by the nurse? a. Trachea During a follow-up visit one week after starting the medication, the patient tells the nurse, "In the last week, my urine turned orange, and I am very worried about it." Implement NPO orders for 6 to 12 hours before the test. The alcohol intake of the patient is within normal limits, so it is not correct to say that alcohol may have damaged the liver. a. Assess the patient for iodine allergy. Which immediate action does the nurse take? a. Retrieved February 9, 2022, from, Testing for Sepsis. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. c. Check the position of the probe on the finger or earlobe. c. Determine the need for suctioning. 6. After which diagnostic study should the nurse observe the patient for symptoms of a pneumothorax? If the probe is intact at the site and perfusion is adequate, an ABG analysis will be ordered by the HCP to verify accuracy, and oxygen may be administered, depending on the patient's condition and the assessment of respiratory and cardiac status. Stridor is identified with auscultation. Teach the proper technique of doing pursed-lip breathing, various ways of relaxation, and abdominal breathing. Fluids help the kidneys filter and flush waste products preventing renal and urinary infections. 1. It is important to acknowledge their limited information about the disease process and start educating him/her from there. As such, here are the signs and symptoms that demonstrate the presence of impaired gas exchange. a. SpO2 of 92%; PaO2 of 65 mm Hg Given a square matrix [A], write a single line MATLAB command that will create a new matrix [Aug] that consists of the original matrix [A] augmented by an identity matrix [I]. Priority Decision: F.N. (2020, June 15). Peripheral chemoreceptors in the carotid and aortic bodies also respond to increases in PaCO2 to stimulate the respiratory center. These practices further reduce the risk of contamination. 2. c. Turbinates Volume of air in lungs after normal exhalation, a. Vt: (3) Volume of air inhaled and exhaled with each breath Alveolar-capillary membrane changes (inflammatory effects) 1) SpO2 of 85% 2) PaCO2 of 65 mm Hg 3) Thick yellow mucus expectorant 4) Respiratory rate of 24 breaths/minute 5) Dullness to percussion over the affected area Click the card to flip Priority Decision: When F.N. Pneumonia causing increased pus and mucus in the alveoli will interfere with gas exchange and oxygenation. To assess the extent and symmetry of chest movement, the nurse places the hands over the lower anterior chest wall along the costal margin and moves them inward until the thumbs meet at the midline and then asks the patient to breathe deeply and observes the movement of the thumbs away from each other. d. Apply an ice pack to the back of the neck. a. Esophageal speech If the patient is ambulatory, walking should be encouraged within the patients tolerance. A patient with pneumonia is at high risk of getting fatigued and overexertion because of the increased need for oxygen demands in the body. What is a primary nursing responsibility after obtaining a blood specimen for ABGs? The respiratory rate, pulse rate, and BP will all increase with decreased oxygenation when compared to the patient's own normal results. d. Direct the family members to the waiting room. h. FRC b. Palpation Collaboration: In planning the care for a patient with a tracheostomy who has been stable and is to be discharged later in the day, the registered nurse (RN) may delegate which interventions to the licensed practical/vocational nurse (LPN/VN) (select all that apply)? Please follow your facilities guidelines, policies, and procedures. Encourage movement and positioning.Mobile patients should be encouraged to ambulate several times a day to mobilize secretions. Nursing diagnoses handbook: An evidence-based guide to planning care. f. PEFR 4. Priority Decision: The nurse receives an evening report on a patient who underwent posterior nasal packing for epistaxis earlier in the day. Fungal pneumonia is caused by inhaling fungal spores that can come from dust, soil, and droppings of rodents, bats, birds or other animals. d. Testing causes a 10-mm red, indurated area at the injection site. 2. If they cannot, sputum can be obtained via suctioning. The 150 mL of air is dead space in the trachea and bronchi. It can have too much oxygen or carbon dioxide in the body which is not very beneficial to the organs or systems. deep inspiratory crackles (rales) caused by respiratory secretions, and circumoral cyanosis (a late finding). How to use esophageal speech to communicate Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Tuberculosis frequently presents with a dry cough. h. Role-relationship: Loss of roles at work or home, exposure to respiratory toxins at work a. c. Explain the test before the patient signs the informed consent form. Health perception-health management 3 Nursing care plans for pneumonia. How does the nurse assess the patient's chest expansion? Hyperkalemia is not occurring and will not directly affect oxygenation initially. Better Health Channel. The patient will also be able to reach maximum lung expansion with proper ventilation to keep up with the demands of the body. Stop feeding when the patient is lying flat. Post author: Post published: February 17, 2023 Post category: orange curriculum controversy Post comments: toys shops in istanbul, turkey toys shops in istanbul, turkey b. Nutritional-metabolic Buy on Amazon, Silvestri, L. A. 3. A risk nursing diagnosis describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community. What does the nurse teach the patient with intermittent allergic rhinitis is the most effective way to decrease allergic symptoms? On inspection, the throat is reddened and edematous with patchy yellow exudates. It involves the inflammation of the air sacs called alveoli. Pneumonia: Bacterial or viral infections in the lungs . The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time. Also called nosocomial pneumonia, this type of pneumonia originates from being admitted in the hospital. The nurse is caring for a patient who experiences shortness of breath, severe productive cough, and fever. a. Deflate the cuff, then remove and suction the inner cannula. If the patient is having increased mucous production, encourage him or her to clear the airway. Cough and sore throat 1. The patient needs to be able to effectively remove these secretions to maintain a patent airway. Cleveland Clinic. Primary care, with acute or intensive care hospitalization due to complications. When F.N. Aspiration pneumonia is a nonbacterial (anaerobic) cause of hospital-associated pneumonia that results from aspiration of gastric contents. The most common. After the intervention, the patients airway is free of incidental breath sounds. c. Decreased chest wall compliance The treatment and medication should be prescribed by the attending physician and do not take meds that are not prescribed to prevent unnecessary drug interaction. Major nursing care planning goals for COVID-19 may include: Establishing goals, interventions. Avoid instillation of saline during suctioning. This patient is older and short of breath. d. Anterior then posterior Buy on Amazon, Gulanick, M., & Myers, J. L. (2022). Assess lung sounds and vital signs. Watch for signs and symptoms of respiratory distress and report them promptly. Bronchoconstriction Physical examination of the lungs indicates dullness to percussion and decreased breath sounds on auscultation over the involved segment of the lung. was admitted, examination of his nose revealed clear drainage. Allow 90 minutes for. Building up secretions in the airway will only cause a problem since it will obstruct the airflow from going in and out of the body. b. e. FVC: (5) Amount of air that can be quickly and forcefully exhaled after maximum inspiration What are possible explanations for this behavior? b. Partial obstruction of trachea or larynx Severely immunosuppressed patients are affected not only by bacteria but also by viruses (cytomegalovirus) and fungi (Candida, Aspergillus, Pneumocystis jirovecii). Saunders comprehensive review for the NCLEX-RN examination. Desired Outcome: Within 1 hour of nursing interventions, the patient will have oxygen saturation of greater than 90%. Symptoms Altered consciousness Anxiety Changes in arterial blood gases (ABGs) Chest Tightness Coughing, with yellow sticky sputum To determine the tracheal position, the nurse places the index fingers on either side of the trachea just above the suprasternal notch and gently presses backward. Administer antibiotics.A diagnosis of pneumonia will warrant antibiotic treatment. The nurse expects which treatment plan? a. Stridor Normal venous blood gas values reflect the normal uptake of oxygen from arterial blood and the release of carbon dioxide from cells into the blood, resulting in a much lower PaO2 and an increased PaCO2. Goal/Desired Outcome Short-term goal: The patient will remain free from signs of respiratory distress and her oxygen saturation will remain higher than 96% for the duration of the shift. The most common is a cough producing purulent sputum (often dark brown) that is foul smelling and foul tasting. c. Use cromolyn nasal spray prophylactically year-round. f) 2. 1. Bilateral ecchymosis of eyes (raccoon eyes) Nurses also play a role in preventing pneumonia through education. 2 8 Nursing diagnosis for pneumonia. A) Seizures Priority Decision: A patient's tracheostomy tube becomes dislodged with vigorous coughing. It must include the local 911 numbers, hospitals, and immediate keen of the patient. d. A tracheostomy tube and mechanical ventilation, What should the nurse include in discharge teaching for the patient with a total laryngectomy? A patient with a 10-year history of regular (three beers per week) alcohol consumption began taking rifampin to treat tuberculosis (TB). This leads to excess or deficit of oxygen at the alveolar capillary membrane with impaired carbon dioxide elimination. The bacteria may enter the blood stream and cause, Trouble sleeping. During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include? Decreased functional cilia and decreased force of cough from declining muscle strength cause decreased secretion clearance. Increased fluid intake decreases viscosity of sputum, making it easier to lift and cough up. What priority discharge teaching should the nurse provide? 2. b. Surfactant f. PEFR: (6) Maximum rate of airflow during forced expiration A) 1, 2, 3, 4 d. SpO2 of 88%; PaO2 of 55 mm Hg What Are Some Nursing Diagnosis for COPD? b. Stridor Arterial blood gases measure the levels of oxygen and carbon dioxide in the blood. a. 3.5 Acute Pain. Tachycardia (resting heart rate [HR] more than 100 bpm). A combination of excess CO2 and H2O results in carbonic acid, which lowers the pH of cerebrospinal fluid and stimulates an increase in the respiratory rate. a. A specimen of the sputum, which is yellow, has been obtained, but the laboratory results are pending. It reduces the pressure needed to inflate the alveoli and decreases the tendency of the alveoli to collapse. Assess for mental status changes. c. Mucociliary clearance Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). These values may be adequate for patients with chronic hypoxemia if no cardiac problems occur but will affect the patients' activity tolerance. Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, have respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96%, and verbalize ease of breathing. Assist with respiratory devices and techniques.Flutter valves mobilize secretions facilitating airway clearance while incentive spirometers expand the lungs. Doing activities at the same time will only increase the demands of oxygen in the body, and patients with pneumonia cannot tolerate it. 7. Warm and moisturize inhaled air Immunotherapy may be indicated if specific allergens are identified and cannot be avoided. d. Notify the health care provider of the change in baseline PaO2. Finger clubbing and accessory muscle use are identified with inspection. There is alteration in the normal respiratory process of an individual. h. Role-relationship Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range. c. The necessity of never covering the laryngectomy stoma An open reduction and internal fixation of the tibia were performed the day of the trauma. Guillain-Barr syndrome, illicit drug use, and recent abdominal surgery do not put the patient at an increased risk for aspiration pneumonia. 28: Obstructive Pulmonary Diseases. This also increases the risk for aspiration pneumonia. The process of gas exchange, called diffusion, happens between the alveoli and the pulmonary capillaries. Lung consolidation with fluid or exudate It may also stimulate coughing. b. Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). a. Finger clubbing Intervene quickly if respiratory rate increases, breathing becomes labored, accessory muscles are used, or oxygen saturation levels drop. Always maintain sterility or aseptic techniques when performing any invasive procedure. "Only health care workers in contact with high-risk patients should be immunized each year." g. Position the patient sitting upright with the elbows on an over-the-bed table. Assess the need for hyperinflation therapy. Urinary antigen test: To detect Legionella pneumophila and Streptococcus pneumoniae. Since the patients body is having difficulty with gas exchange due to pneumonia, it will benefit him/her to have some supplementary oxygen treatment to assist in the demands of the body. RR 24 4) Cough suppressants and antihistamines should not be used. Advise individuals who smoke to stop smoking, especially during the preoperative and postoperative periods. General physical assessment findingsof pneumonia. 7. b. Implement precautions to prevent infection.Proper handwashing is the best way to prevent and control the spread of infection. However, here are some potential NANDA nursing diagnoses that may be applicable: Impaired gas exchange related to decreased lung expansion and ventilation-perfusion imbalance; . Order stat ABGs to confirm the SpO2 with a SaO2. A significant increase in oxygen demand to maintain O2 saturation greater than 92% should be reported immediately. Coarse crackling sounds are a sign that the patient is coughing. A patient with pneumonia shows inflammation in their lung parenchyma causing it to have. Discuss to him/her the different pros and cons of complying with the treatment regimen.
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