Nursing Diagnosis: Impaired Physical Mobility. Risk Factors: bed rest, bowel incontinence. Sibbald RG, Campbell K, Coutts P, Queen D. Ostomy Wound Manage. Allows for enjoyment and relaxation without the risk of falling to temptation. Calorie-burning activities and exercises can also help over-nourished patients maintain a healthy weight. Which assessment is most supportive of the nursing diagnosis, impaired skin integrity related to purulent inflammation of dermal layers as evidenced by purulent drainage and erythema? A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms. Putting legs on dependent position will worsen leg edema. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Advise the patient to avoid walking in bare feet.The patient should wear footwear at all times. Sacral sores are prone to infection due to its location. Skin is affected by both intrinsic and extrinsic factors. Thus, ensuring that the patient is adequately hydrated minimizes the risk of illness and infection. (adsbygoogle = window.adsbygoogle || []).push({}); - Along with a turning schedule, patients should be assessed for any bodily secretions. Desired outcome: Patient will not experience worsening of pressure ulcer. She received her RN license in 1997. An official website of the United States government. Imbalanced Nutrition: Less than the body requirements, Disturbed Sleep Pattern Nursing Diagnosis, Hypothyroidism Nursing Diagnosis and Nursing Care Plans, Wound Infection Nursing Diagnosis and Nursing Care Plans. Proper intake of fluids increases oxygen and nutrient delivery to the wound bed by increasing the blood volume. St. Louis, MO: Elsevier. Use of the Braden Skin Assessment Scale will assist in . Measure the volume of urine output. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Has 8 years experience. Assess vital signs and monitor the signs of infection. Assess for fecal and/or urinary incontinence. However, by taking. She earned her BSN at Western Governors University. She has worked in Medical-Surgical, Telemetry, ICU and the ER. Assess the cause of immobility.Causes of impaired mobility can be physical, psychological, and motivational. Because of physiologic changes, such as difficulty in swallowing, chewing, and the decline in the sense of taste and smell, the desire to eat or consume meals is decreased. The energy level in malnourished patients is typically lower than that in a healthy person. impaired Skin/Tissue Integrity may be related to infectious lesions, possibly evidenced by disruption of skin surfaces and mucous membranes. Assess the ability of the patient to mobilize. 4. Bekiaridou A, Karlafti E, Oikonomou IM, Ioannidis A, Papavramidis TS. Checklist and Communication Tool for Patients Carers. Abstract. If not contraindicated, consider seasoning for patients who have an impaired sense of taste. Extrinsic factors include falls, accidents, pressure, immobility, and surgical procedures. Baseline data will help in the evaluation of progress after interventions are made. These techniques will encourage patients to take an active role in developing, implementing, and evaluating their own treatment plans for fatigue relief. Protein deficiency may result from a low nitrogen balance, necessitating further intervention. Patients skin will remains intact, as evidenced by: no redness over bony prominences, and capillary refill less than 6 seconds over areas of redness. The patient will exhibit intact skin or tissues with absent excoriation. When the infection spreads to the soft tissues and bones, it can lead to lower-limb amputation. Key features: A practical, accessible, evidence-based manual on wound care and skin integrity Integrates related aspects of skin integrity, wound management and dermatology previously found in separate texts into one comprehensive resource Written from a broad international perspective with contributions from key international opinion leaders . 2]. (Nursing Care Plans for Impaired Skin Integrity) Nursing Care Plans for Impaired Skin Integrity Nursing Care Plans for Impaired Skin Integrity: Care Plan 3 - Diagnosis: Pressure ulcers / Bedsores. . Bethesda, MD 20894, Web Policies The study reported here describes a 1 year programme to promote best practice in maintaining skin integrity . Date:- It will also help in the regular assessment in the progress of nursing care. Available from: Foot and Toe Ulcers. Unable to load your collection due to an error, Unable to load your delegates due to an error. Evidence-based nursing intervention to reduce skin integrity impairment in children with diaper dermatitis: A systematic review . Learn how your comment data is processed. 2) Risk assessment includes identifying whether a skin break is present or not. 4. Related to prescribed bed rest" is the etiology of the statement. My instructor is a stickler too! 2022 Dec 12;12(12):1852. doi: 10.3390/biom12121852. Impaired skin integrity related to edema formation secondary to Kawasaki disease. Assessing the changes in the patients vital signs can provide early indications of inadequate circulating fluid. Vitamin A deficiency is associated with dry eyes and an increased risk of infection. Methodologically, I will introduce a breakthrough by linking macroeconomic analysis with an original evidence-based representation of investment decisions based on forward-looking expectations of transition pathways. Risk for impaired skin integrity. Screening and Physical Examination. An albumin level greater than 2.5 g/100 ml is a grave sign, indicating severe protein depletion. evidenced by inflammation dry flaky skin erosions excoriations fissures pruritus pain blisters desired outcomes the patient will maintain optimal skin integrity within the Nursing Diagnosis: Imbalanced Nutrition: Less than the body requirements related to reluctance to consume meals, secondary to malnutrition as evidenced by an imbalance in electrolytes, ineffective healing of wounds, reductions in the level of protein, transferrin, and serum albumin concentration, loss of muscle tone and a weight decrease of less than 20%. :imbar. allnurses is a Nursing Career & Support site for Nurses and Students. These problems can impede digestion, vitamin absorption, and the production of hormones that control metabolism. It involves extensive and complete removal of dead tissue even beyond the area of necrosis. Impaired skin integrity is characterized by the following signs and symptoms: Affected area hot, tender to touch; Damaged or destroyed tissue (e.g., cornea, mucous membranes, integumentary, subcutaneous) . A low-air loss mattress alternates inflating and deflating to mimic the shifting of a patient in bed which helps in repositioning and relieving pressure. 2003 Jun;49(6):27-8, 30, 33 passim, contd. Patients may not notice injury. The twenty-first century clinician has several online, evidence-based tools to assist with optimal treatment plans. Skin Integrity Rick Hansen. Its three main purposes are: (1) to protect the body, (2) to regulate temperature, and (3) to provide sensation. 1. Proper application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection. She has worked in Medical-Surgical, Telemetry, ICU and the ER. Evaluate the patients nutritional knowledge and comprehension, including his/her perception of the most pressing need. Regular assessment of the skin is critical for those at risk for impaired skin integrity. The diet should be rich in nutrients such as carbs, fats, proteins, minerals, and vitamins. Anything that affects metabolic and cardiopulmonary processes also increases risk for infection so if she's got altered circulation, altered respirations, altered nutrition status, immunocompromised, etc you could relate these to the risk for infection as well. Writing a clear-effective nursing care plan for impaired tissue integrity can be challenging for most students and even nursed on duty. National Library of Medicine The doctor may also prescribe oral antibiotic drugs in patients who have a lot of impetigo sores. Perform skin assessments. * After bathing, allow the skin to air dry or gently pat the skin dry. Pressure release mattresses and cushions are helpful to prevent sores from occurring and they help spread equal pressure to the body when sitting and lying down. Diabetes stage 3 ulcers are a significant condition that . As an Amazon Associate I earn from qualifying purchases. Nursing care plans: Diagnoses, interventions, & outcomes. (adsbygoogle = window.adsbygoogle || []).push({}); Patients Diagnosis: Consult a dietician for an in-depth review of the patients nutritional state and available nutritional support. Experts (e.g., nutritionists) can use nitrogen balance to measure the patients nutritional state. Perform wound care per guidelines and orders, Wound care differs depending on the type of skin breakdown, location on the body, and size of the wound. St. Louis, MO: Elsevier. sharing sensitive information, make sure youre on a federal Nursing care plans: Diagnoses, interventions, & outcomes. Risk for impaired skin integrity related to prolonged immobility, poor skin turgor, poor circulation or altered sensation (use one) Objective. Supplementation should only be done under the guidance of a qualified healthcare provider. The result is a decrease in the weight-for-height index, stunting, and considerable change in BMI (underweight). Assess the patients fluid balance and determine the steps necessary to restore or maintain it. Instead of showering daily, suggest bathing on alternate days. Depending on the type and thickness of the wound, this can include hydrocolloid dressings, absorptive dressings, alginate dressings, hydrogels, silver nitrate, and wound vacs. She found a passion in the ER and has stayed in this department for 30 years. Pressure injuries are localized areas of soft tissue damage that typically occur in older adult populations, people with limited mobility or who are confined to the bed or chair, who underwent injury or surgery, and clients who have impaired nutrition. Intact skin--an integrity not to be lost. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Regularly assess condition for bedsores. SCIENTIFIC BASIS According to the NANDA risk for impaired skin integrity is defined as susceptible alteration in epidermis and/or dermis, which may compromise health. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population. The patients social support will be crucial in helping him, or her implement modifications to reduce exhaustion. Since 1997, allnurses is trusted by nurses around the globe. Correcting fluid imbalances is more likely to succeed if the patient is involved in the process of planning. Please follow your facilities guidelines, policies, and procedures. Buy on Amazon, Silvestri, L. A. Oliver TI, Mutluoglu M. [Updated 2022 Aug 8]. Improves skin circulation and perfusion by reducing long-term strain on the tissues. Intake of high protein foods and supplements is essential for repairing body tissues. Encourage proper hydration. CLICK HERE for Free NCLEX RN & CGFNS Practice Questions. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). This is especially true in cases of disturbed body image and for patients suffering from bulimia. It is important that nurses understand how to assess, prevent, treat, and educate patients on impaired skin integrity. Educate on diabetic neuropathy and the importance of daily skin checks. Desired outcome: Patient will have healed left ankle wound and further skin damage will be prevented. Consider discussing with a physician to determine nutrient deficiencies. Please follow your facilities guidelines and policies and procedures. Any break in the skin or other compromise in the bodys first line of defense can lead to pathogens possible entrance into the body. Please enable it to take advantage of the complete set of features! HHS Vulnerability Disclosure, Help 2022 Sep 16;10(9):e4513. The patients vital signs are within normal range. Healthline. Desired Outcome . Recovered from dry skin. Ulcers most commonly occur on the plantar surface of the foot, including the heel and tips of hammer toes. Development of a Tool for Pressure Ulcer Risk Assessment. acute Pain/impaired Comfort may be related to exposure of irritated skin and mucous membranes to excretions (urine, feces), possibly evidenced by verbal or coded reports, restlessness, or guarding behaviors. Patients with diabetic foot ulcers may experience impaired physical mobility from their wound or amputation. Assess the patients body weight in relation to his/her age and height. Providing pain relief will help encourage patients to mobilize and change position. It is possible to become malnourished due to a lacking dietary intake. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Desired Outcomes. Patient will demonstrate three ways to prevent impaired skin integrity ; Pressure ulcer will improve as evidenced by a reduction in size and absence of drainage ; Impaired Skin Integrity Assessment. Buy on Amazon, Silvestri, L. A. Increase tissue perfusion by massaging around affected area. These may include diseases such as celiac disease, Crohns disease, and systemic infection in the intestines. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. 2. An albumin level greater than 2.5 g/100 ml is a grave sign, indicating severe protein depletion. The loss of sensation results in ongoing trauma, skin breakdown, and ulcer development. Request PDF | Impaired mitophagy causes mitochondrial DNA leakage and STING activation in ultraviolet B-irradiated human keratinocytes HaCaT | Ultraviolet B (UVB) irradiation causes skin damages . Encourage use of footwear at all time. Pictures and descriptive words can also be used to construct additional rating scales. Thereby, minimizing the use of energy is essential. Building trust begins with listening attentively to the patients concerns and questions. Intervention. Depending on the medical plan, the patient may have to undergo surgical treatment. Br J Nurs. Encourage the patient on skin care.The patient should keep their skin moisturized, clean, and dry to prevent breakdown. Ascertain that the patient consumes a nutritionally balanced diet that includes adequate hydration. If powder is desirable, use medical-grade cornstarch; avoid talc. Best practice guidelines (BPGs) are systematically developed, evidence-based documents that include recommendations for nurses and the interprofessional team, educators, leaders and policy-makers, persons and their chosen families on specific clinical and healthy work environment topics. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Some patients with diabetic foot ulcers do not move due to pain, fear of failing, or depression. Patients may have tachycardia and increased blood pressure reading on their vitals. Nursing diagnoses handbook: An evidence-based guide to planning care. Some of the most frequent deficits and their associated symptoms are as follows: Whereas over-nourished patients are more prone to the development of these diseases: Malnutrition may be caused by a variety of factors. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Gardiner L et al Evidence based best practice in. To preserve integrity to the rest of the skin. By lending the patient a helping hand, dehydration or continuous fluid loss may be prevented. I always got big red Xs on my concept maps whenever I tried to use pain because the instructors say its redundant and that I'm being lazy. St. Louis, MO: Elsevier. She found a passion in the ER and has stayed in this department for 30 years. Ask the patient to keep a journal to record and track his/her level of exhaustion or activity. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Otherwise, scroll down to view this completed care plan. The patient will begin to search for information on overnutrition and undernutrition. Although obesity does not affect the skin's capacity to synthesize vitamin D, greater amounts of subcutaneous fat sequester more of the vitamin and alter its release into the circulation. Nursing Diagnosis: Impaired skin integrity (pressure ulcers) secondary to decreased mobility as evidenced by presence of stage 2 pressure ulcer on the sacrum. Stoma following surgery should be moist and pink-red in color. Identifying and addressing the underlying problems. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Read More Readiness for Enhanced Nutrition Nursing Diagnosis & Care PlanContinue. Nutritional deficits can make a patient appear lethargic and exhausted. The individual should have enough loss of sensation to have more than normal risk to the skin and musculoskeletal structures. Administer antibiotics as prescribed. The exact reason for wanting to change a dietary lifestyle can vary from person to person. Educate the patient on strategies for achieving adequate food intake and a balanced diet when he/she is away from the comfort of their homes. Anna Curran. Patients who may have adequate mobility but are under the use of restraints are also at risk. Assess for fecal/urinary incontinence. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. 1. 2022 Jan 15;12(2):275. doi: 10.3390/nano12020275. A brief description of these causes is provided in the following. Assess patient's nutritional status, including weight, weight loss, and serum albumin levels. - Blood filled tissue due to underlying tissue damage. Risk for infection r/t a site for organism invastion secondary to episiotomy. Refer to a wound care specialist.Complicated, infected, or non-healing wounds require treatment at a wound care center with ongoing assessment from a wound care team. Accessibility Assess amount of shear (pressure exerted laterally) and friction (rubbing) on patient's skin. Kwashiorkor patients experience fluid retention and a protruding abdomen as a result of protein deficiency. Please read our disclaimer. This puts the patient at risk for impaired skin integrity if they cannot feel the normal sensations of pain or pressure. Monitor for signs of infection such as redness, swelling, or drainage. Lenz TL, Monaghan MS. An evidence-based review of fat . Our website services and content are for informational purposes only. An elevated white blood count also signals an infection. In more serious situations, hospitalization may be necessary. Nevertheless, the information provided by Figs. . Impaired skin integrity is only used for wounds that only go as deep as the epidermis and heal in a week. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. This results in symptoms of burning and numbness as well as reduced sensation. Desired Outcome: The patient will be able to experience optimal wound healing and avoid the spread of infection to the rest of the skin to preserve its integrity. surface bowel or bladder incontinence evidenced by skin lesions and ulcerations erythema over bony prominences desired outcomes after implementation of nursing . Proper measuring of the adhesive wafer and fitting of the pouch system will help with sealing around the stoma to prevent leakage and peristomal skin irritation. Ensure tight glycemic control.Uncontrolled diabetes prevents wound healing from reducing oxygenation to tissues. Due to decreased sensation to the lower legs and feet, the patient must keep feet protected to prevent skin injury. Removal of scabs prior to applying the topical antibiotic promotes good absorption of the medication. Provide pain relief as needed. Ascertain that the patient is receiving adequate nutrition. Postural hypotension can occur due to injury and risk of falls after suddenly shifting the body position (e.g., standing, sitting). Pain is what the pt. Provide supplementation of zinc, iron, iodine, and other food supplements. Assist in creating a relaxing atmosphere for the patient. Wounds must be staged correctly including length, width, and depth with detailed descriptions of drainage, peri-wound area, odor, and any tunneling or undermining. Dressings containing silver compounds are helpful in addressing topical and direct antibiotic treatment of the affected tissues. Problems with social interaction and mobility. They must inspect their feet and lower legs daily for open areas. There are a lot of people suffering from malnutrition. potential or risk for impaired skin integrity hour skin assessment on any resident Skin Integrity . a. Intervention. As an Amazon Associate I earn from qualifying purchases. Assess the vital signs of the patient. Remind the patient to inspect the feet daily.Patients with neuropathy or peripheral vascular disease may not be able to feel when they have cut their skin. Federal government websites often end in .gov or .mil. A. a heart rate of 88 beats/minute B. wound healing by primary intention C. oral temperature of 101 F (38.3 C) D. dry and intact wound dressing Educate on proper fitting and emptying of the ostomy pouch. One of the symptoms of malnutrition is having dry, thick skin. The greatest risk factor in skin breakdown is immobility. A diabetic foot ulcer is one of the most common complications diagnosed in patients with uncontrolled diabetes mellitus. If the infection is mild and have not spread to other areas of the body, the sores can be treated through the use of over-the-counter antibiotic cream containing bacitracin, as a home remedy. Recommend adaptive equipment as prescribed by an occupational therapist to patients with physical disabilities. Diabetic Foot Ulcers. The patient will indicate the absence of pruritus/scratching. Assess skin integrity taking note of color, moisture, texture, and pulses regularly. Unauthorized use of these marks is strictly prohibited. When a surgeon cuts into the body to repair a hernia, there is impaired tissue integrity. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Malnutrition is more likely among people who are fragile, have poor movement, or lack muscle power because of their inability to collect and prepare meals. High blood sugar levels result from diabetes, a chronic disease that impairs the body's ability to make or use insulin. Assist him/her in employing techniques to prevent vomiting. New stoma creation requires assessment and education from a wound care/ostomy specialist to ensure the stoma is healing properly and the correct ostomy supplies are being used to fit the stoma correctly. Evaluate the patients laboratory results. Copyright 2017 Elsevier Inc. All rights reserved. Deficiencies in nutrient absorption. Advise the patient and caregiver to prevent scratching the affected areas. St. Louis, MO: Elsevier. For patients with impaired perception, family members may be able to provide more accurate information on their food intake. To keep weight under control while having fun socially, using smart eating strategies, whether dining out or traveling, is advisable. 2. Risk for Infection Nursing Diagnosis & Care Plan, Ineffective Tissue Perfusion Nursing Diagnosis & Care Plan, Deficient Fluid Volume Nursing Diagnosis & Care Plan, Activity Intolerance Nursing Diagnosis & Care Plan, https://www.ncbi.nlm.nih.gov/books/NBK2650/table/ch12.t2/, https://www.woundsource.com/blog/understanding-braden-scale-focus-sensory-perception-part-1, https://www.in.gov/health/files/Braden_Scale.pdf, Ineffective Breathing Pattern r/t deep, fast breathing as a compensatory mechanism of metabolic acidosis, Deficient Fluid Volume r/t increased urination and vomiting, Imbalanced Nutrition: Less Than Body requirements r/t bodys inability to use glucose, nausea, vomiting, Deficient Knowledge r/t new onset of diabetes mellitus, Read More DKA Nursing Diagnosis and Care PlanContinue, NANDA-I Definition: Intake of nutrients that exceeds metabolic needs Related, Read More Imbalanced Nutrition: More Than Body Requirements [Nursing Care Plan]Continue. Individuals who are malnourished may suffer from the following: 5. He/she could also substitute fluid in place of calories, which in turn disrupts the fluid balance in the body. Assess and record the integrity of skin. Buy on Amazon, Gulanick, M., & Myers, J. L. (2022). Patient recovery and prognosis can be adversely affected by fluid retention, electrolyte changes, and impaired renal function. Patients who are unable to ask for assistance to use the bathroom or are incontinent need frequent monitoring to keep skin dry and clean. Assist with debridement.Wounds with necrotic tissue or nonviable tissue must be removed to allow for treatment and healing. 60% of patients with diabetes will develop neuropathy, increasing the risk of foot ulcers. It can cause major health problems, such as growth retardation, vision problems, diabetes, and cardiovascular disease. The only thing about pain (because i used that as an answer once and got it wrong) is that our instructors wanted "evidence" that you could. - Area is usually over a bony prominence. Elderly, especially those who live alone or are disabled. 2. Radiated skin becomes thin and friable, may have less blood supply, and is at higher risk for breakdown. Observe the patients eating environment. Create well-written care plans that meets your patient's health goals. Make eating and exercising a social event. Journaling daily can help patients determine the times of day in which they are most rested. 4. Understanding best practices in addressing skin . The site is secure. Nursing Diagnosis: Impaired skin integrity (pressure ulcers) secondary to decreased mobility as evidenced by presence of stage 2 pressure ulcer on the sacrum. Examples Client Outcomes For Impaired Skin Integrity Pdf Right here, we have countless ebook Examples Client Outcomes For Impaired Skin Integrity Pdf and collections to check out. Undernourished individuals may exhibit one or more of the symptoms listed below: Undernourishment can lead to major physical and health problems, which in turn can raise the chance of death. c. Demonstrated ways on how to maintain uncompromised skin integrity. Administer antibiotics.Severely infected diabetic foot ulcers may require inpatient hospitalization and IV antibiotics. Consequently, they may not consume enough nutrients to meet the bodys needs. Impaired Skin Integrity - Dermatitis Nursing Care Plans Common Related Factor Defining Characteristics Contact with irritants or allergens Inflammation Dry, flaky skin Erosions, excoriations, fissures Pruritus, pain, blisters Common Expected Outcome Patient maintains optimal skin integrity within limits of the disease, as evidenced by intact skin. Skin is the largest organ in our body which protects from heat, light, injury and . Eating is less likely to be used as a coping method for emotional distress. Check water temperature when washing feet. Alcohol includes calories; thus, a chronic alcohol user may not feel hungry after drinking. 2 Focus Note James is a 79-year-old male patient with a three-year history of increased glucose levels. A prosthetist is trained to work with those with disabilities and instruct on the wear and use of the prosthetic for optimal mobility. Isn't it evidenced by seeing the surgical incision? Refer to physiotherapy. A diabetic foot ulcer is an open sore that looks like a round crater with thick calluses as borders. Evidenced by the presence of a stage 2 pressure ulcer on the sacrum. Desired Outcome: Patient's bedsore will show optimal healing, and further bedsores will be prevented. Activity intolerance is a nursing diagnosis defined by NANDA as insufficient physiological or psychological energy to continue or complete necessary or desired activities. Make a report on the patients actual weight and not an approximation. It can become deep enough to expose tendons or bone. Overall, the most effective treatment options may be contingent on identifying the source of malnutrition. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Educate the patient on the use of laxatives and diuretic medications. In order to aid patients and healthcare practitioners in diagnosing and treating nutritional deficiencies, it is necessary to understand the signs and symptoms of malnutrition. To determine the severity of impetigo and any affected areas that require special attention or wound care. Has 4 years experience. Dehydration can cause further skin injury due to skin dryness. Nursing Diagnosis: Risk for Impaired Skin Integrity related to loss of subcutaneous fat, secondary to malnutrition, as evidenced by inadequate dietary intake, anorexia, nausea, vomiting, and difficulty to absorb nutrients.
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