If the patient exhibits these symptoms, contact the doctor or go to the emergency room. Assist the patient in performing passive or active ROM exercises on all extremities. Determine and explain common seizure patterns as well as seizure warning indicators (if applicable). The care of the underlying illness that was identified through the evaluation of the neurological symptoms and signs is necessary for the treatment of metabolic encephalopathy. Please read our disclaimer. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Some patients, particularly the elderly or terminally ill, see themselves as reliant on the care provider and, as a result, refuse to participate in the learning process. When recognized, the patient verbalizes his or her understanding of the potential causes. Give the patient a chance to express their worries, anxieties, emotions, and expectations. 5. For the other types, here are the ways to prevent encephalopathy: Several of the causal factors of encephalopathy can be avoided by making the modifications listed below: Nursing Diagnosis: Confusion related to toxins secondary to encephalopathy as evidenced by misconceived notions, cognition fluctuation, increased irritability, a shift in the sleep-wake cycle, and hallucinations, either auditory or visual. Please follow your facilities guidelines, policies, and procedures. A medication box can help remind patients to take their medications at the appropriate times and replenish the box. The patient will engage in physical activity on their own or within their conditions limitations. The patient will be able to understand what encephalopathy is and will also learn its management, treatment, and prevention. A patient is diagnosed with hypertension, the medical term for high blood pressure, when their blood pressure is 140/90 mmHg most of the time. Allow the patient to speak freely about prior experiences and health education. Hepatic encephalopathy patients may appear confused or struggle to process their thoughts. Hemorrhage and bleeding risk are increased by clotting deficiencies. Present the reality to the patient succinctly and straightforwardly. Frequency The male-to-female ratio is 1.7:1, likely owing to alcoholism being 3-4 times more frequent in men than in women. Patients must see the need or a reason to learn. This also provides information regarding the effects of therapy and replacement needs. Invite family members to participate in the reorientation and to keep providing comments (e.g., latest events and family gatherings). Hepatic Encephalopathy Nursing Care Plan 4 Nursing Diagnosis: Risk for Deficient Fluid Volume related to third-space shift, excessive fluid losses through vomiting and diarrhea, and alteration in the clotting process secondary to hepatic encephalopathy. Nursing care plans: Diagnoses, interventions, & outcomes. Brain tumor or increased pressure in the skull, Prolonged exposure to toxic elements (including solvents, drugs, radiation, paints, industrial chemicals, and certain metals), Lack of oxygen or blood flow to the brain, Progressive loss of memory and cognitive ability, Myoclonus (involuntary twitching of a muscle or group of muscles), Nystagmus (rapid, involuntary eye movement). However, they could cause brain damage if neglected. There are several levels of hypertension: Normal Blood Pressure: Lower than 120/ 80. A detailed history, examination and investigations performed during the acute illness (blood sugar, blood gases, plasma ammonia, blood lactate, plasma ketones, plasma amino acids, liver function tests, and urinary organic acids) should identify those patients in whom a metabolic disorder is likely. Protein deficit can lead to muscle breakdown, which increases the release of amino acids and ammonia production, exacerbating or developing hepatic encephalopathy. She found a passion in the ER and has stayed in this department for 30 years. This is connected to excessive salivation. Garca-Garca, R., Cruz-Gmez, .J., Urios, A. et al. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. The care of patients with encephalitis is challenging for nursing staff. This site is protected by reCAPTCHA and the GooglePrivacy Policyand Terms of Serviceapply. An altered mental state is one of the main symptoms of encephalopathy, causing confusion and changes in consciousness. Monitor the patients calorie count and dietary intake. Many of the bodys regulating hormones are produced by the thyroid gland. Diarrhea can be a temporary flu-like reaction to a viral infection, it can signify a more serious issue such as blocked portal blood flow and vascular congestion in the GI tract, or it can be the intended side effect of medication (neomycin, lactulose) use to lower serum ammonia levels in the presence of hepatic encephalopathy. The consent submitted will only be used for data processing originating from this website. As encephalopathy progresses, asterixis, also termed "flapping tremor," is encountered, particularly in hepatic disease, uremia and sedative intoxication. These toxins travel to the brain, affecting its function, and eventually cause cognitive impairment. Consider participating in a clinical trial so clinicians and scientists can learn more about encephalopathy and related disorders. The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. Administer medications to lessen the frequency and duration of delirium episodes as prescribed. Free Care Plans. These types of equipment can accommodate dysfunction and increase activity levels. The patient will demonstrate adequate motor function. This type of encephalopathy is caused by an accumulation of uremic toxins in the blood. The patients delirium occurrences have subsided. Assist the patient in becoming acquainted with their surroundings. Support the patient when doing muscular exercises as they are able or when they are allowed out of bed; perform abdominal-tightening exercises and knee bends; jump on one foot; stand on one toe. Knowledge is used to correct erroneous assumptions about encephalopathy. Posted on October 13, 2014 by stormeelking under Care Plans. Consult a nutritionist and the nutritional support team to prepare a diet tailored to the patients requirements, with as much protein and fat as is acceptable. Educate the patient regarding polypharmacy. Irreversible complications of hepatic encephalopathy include: Diagnostic tests for hepatic encephalopathy usually include: The severity and underlying etiology of hepatic encephalopathy will determine the best course of treatment. Encourage the patient to eat high-calorie, moderate protein meals and supplementary feedings. They can help connect patients with new and upcoming treatment options. 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. This NCLEX review will discuss cirrhosis. Polypharmacy, which is the concurrent use of several pharmaceuticals to treat one or more medical diseases, is linked to poor medication adherence and increases the likelihood of medication misunderstanding between patients and clinicians. Nursing Diagnosis: Acute Confusion Related to: Hepatic encephalopathy (HE) Accumulation of ammonia in the blood As evidenced by: Confusion Agitation Slurred speech Lethargy Impaired decision making Decreased level of consciousness. Nov 4, 2015 - Explore Mone''s board "Nursing: Care Plans & Concept maps", followed by 1,199 people on Pinterest. As a nursing student, you must be familiar with cirrhosis along with how to care for a patient experiencing this disease. Hypoxic-ischemic encephalopathy. Place the patient in a serene, stress-free environment and urged to partake in cognitive activities. The presence of family members and other significant others may increase the patients degree of comfort. Wernickes encephalopathy. Nursing Diagnosis: Acute pain related to urinary tract infection as evidenced by cloudy, foul-smelling urine, patient reports of burning sensation when urinating, and suprapubic cramping and pain rated 7/10. Prion diseases include the following: Uremic encephalopathy. Assess neurological status every 1-2 hours and when necessary until a steady condition. Determine the patients age, developmental stage, health status, lifestyle, impaired communication, sensory-perceptual impairment, mobility, cognitive awareness, and decision-making ability. The verbal expression of actual or perceived dangers can assist lessen anxiety and open the door to further discussion. If the underlying problems are treated, metabolic encephalopathies can be reversible. 3. 3. Review medications.Ensure the patients medication regimen is not contributing to their disturbed thought processes on top of their diagnosis. Take note of gastrointestinal losses such as nausea and diarrhea. Although it may seem redundant, this is essential for the patient who is confused. The patient initiates lifestyle/behavioral changes to prevent or reduce the reoccurrence of the condition. Examine the patient for sensory deprivation, CNS drugs concurrently, poor nutrition, fluid loss, infection, or other concurrent disease processes. Buy on Amazon, Gulanick, M., & Myers, J. L. (2022). These head blows cause nerve damage in the brain. This condition can lead to chronic brain damage or disturbance. (2020). Nursing Diagnosis: Deficient knowledge related to a lack of cognitive information or psychomotor ability required for health reconstruction, maintenance, or advancement secondary to encephalopathy as evidenced by lack of comprehension and progress of serious complications. A nurse's management plan will depend on the type of encephalopathy being treated and its severity. Hashimotos encephalopathy. Increased orientation provides the patient with a higher level of safety. b. Deficient Fluid Volume related to excessive losses. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Start Trial Previous lesson Next lesson Wernicke encephalopathy (WE) is an acute neurological condition characterized by a clinical triad of ophthalmoparesis with nystagmus, ataxia, and confusion. The patient will demonstrate absence of injuries within 4 hours of nursing diagnosis and treatment. Hashimotos encephalopathy. Because the patient may be a poor historian, daily weights and precise tracking of intake and output are necessary. Nursing Diagnosis: Impaired Physical Mobility related to ataxia secondary to metabolic encephalopathy as evidenced by difficulty in movement with purpose in ones physical surroundings, including bed mobility, transferring, and walking; Inability to carry out instructions; a restricted range of motion. Buy on Amazon, Gulanick, M., & Myers, J. L. (2022). These measures establish a safe and secure environment and may reduce the probability of falls. The patient will comply with the treatment plan in order to reduce or stop seizure activity. 9th Edition. Assist with testing and reviewing results to determine mental status based on age and neurocognitive capacity. Review with the patient the requirement of abstaining from alcohol for at least 6 to 12 months, or longer depending on personal tolerance. Wernicke encephalopathy (WE) is an acute neurological condition characterized by a clinical triad of ophthalmoparesis with nystagmus, ataxia, and confusion. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. Promote a calm environment.The patient suffering from encephalopathy tends to misinterpret high levels of auditory and visual stimulation. Infections, toxins, or organ failure can all cause toxic-metabolic encephalopathy. Arrange for consultation with case managers and social workers who should tell patients and families about all of the choices accessible to them, such as at-home PT and OT, day programs, and cognitive rehabilitation programs. Adjust sensory exposure. Blood tests, imaging studies like CT scans or MRI, spinal fluid examination, and electroencephalograms (EEG) may be performed to help diagnose the condition and determine its underlying cause. 3. The patient will report how comfortable they feel handling challenging circumstances in the future. Here are eight (8) nursing care plans (NCP) and nursing diagnosis for patients with liver cirrhosis: ADVERTISEMENTS Imbalanced Nutrition: Less Than Body Requirements Excess Fluid Volume Risk for Impaired Skin Integrity Ineffective Breathing Pattern Risk for Injury Risk for Acute Confusion Disturbed Body Image Deficient Knowledge Maintaining nutritional status will be made easier by this strategy. An MRI or CT scan can identify any brain enlargement or another illness that triggers the symptoms, such as a tumor. Vomiting and nausea often occur together. Symptoms include: Anxiety or irritability. Patients with encephalopathy exhibit altered mental status, causing them to experience disturbed thought processes. Lowering the number of hazardous chemicals, such as pharmaceuticals, that people are exposed. The patient will be admitted and the following common treatments for mild encephalitis may be employed: Anti-inflammatory medicines are used to treat headaches and. 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. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Nursing Diagnosis: Deficient Knowledge related to misinterpretation of information, lack of exposure/recall, and unfamiliarity with resources secondary to hepatic encephalopathy as manifested by verbalization of questions or statements of misconception, inaccurate follow-through of instructions, request for information, and development of preventable complications. Take note of the occurrence and duration of agitation, hallucinations, and violent behaviors. Uremic encephalopathy is an organic brain disorder. Please follow your facilities guidelines, policies, and procedures. It can occur in people with chronic liver disease, such as. Please follow your facilities guidelines, policies, and procedures. Continue with Recommended Cookies, Hepatic Encephalopathy NCLEX Review and Nursing Care Plans. Symptoms of sundowning could include sleep problems, hunger, dehydration, or an inability to meet bowel and bladder demands. Monitor lab work.Ammonia levels, BUN and creatinine, urinalysis, white blood counts and more can signal abnormalities in the liver, kidneys, and infectious processes contributing to symptoms of confusion. This condition, also known as Wernickes disease, is caused by a lack of vitamin B-1. When a patient becomes agitated, reality orientation can help limit or reduce the confusion that increases the risk of injury. 2. The bodys immune system damages the thyroid gland in Hashimotos thyroiditis. Adjust sensory exposure. Suicide is commonly attempted by a patient who is depressed and unable to solve problems. Having a late-night snack offers an additional source of calories, which reduces the gap between meals. Patients with hepatic encephalopathy should get nutritional support that consists of maintaining an energy intake of 3540 kcal/kg/day and a protein intake of 1.21.5 g/kg/day. 3. CSF samples can sometimes be examined to determine the viruses or other pathogens that cause the infection. Detailed analysis and evaluation of nausea can contribute to the identification of strategies to alleviate or reduce the problem. This intervention is done to determine the degree of impairment. She found a passion in the ER and has stayed in this department for 30 years. General Nursing Care Plans Surgery and Perioperative Cardiovascular Endocrine and Metabolic Gastrointestinal and Digestive Genitourinary Hematologic and Lymphatic Infectious Diseases Integumentary Maternal and Newborn Mental Health and Psychiatric Musculoskeletal Neurological Ophthalmic Pediatric Nursing Respiratory Exams All Nursing Test Banks This can support independence. After 4 hours of nursing actions and teaching, the patient will be free of injuries. Maintain complete bed rest if onset symptoms or an aura are observed. Pre-op Bowel surgery; REMEMBER this military sound off: a. . Encephalopathy is not a single disease but rather a group of disorders caused by a variety of factors; it is a severe medical condition that, if left untreated, can result in temporary or permanent brain damage. Create a calm environment by removing unnecessary noise and stimuli. Septic shock, the most severe complication of sepsis, carries a high mortality. This type of encephalopathy arises when the brain is subjected to various traumas or concussions. Toxic Metabolic Encephalopathy: This type of encephalopathy results from toxins, infections, or organ failure. This may assist to lower the trigger of nausea. These factors must be thoroughly evaluated when developing a care plan or educating patients about safety precautions as these may influence the patients ability to protect themselves from harm. Tracking degree of consciousness. The patients level of comfort may increase with the presence of his/her family and the patients significant other. Give simple instructions.Allow the patient to participate in care by giving them simple directions to follow, using short sentences, and allowing them to make decisions using yes/no questions. Ensure patient safety by asking a family member to accompany the patient especially when agitated or impulsive. Speech therapy is used to retrain muscular control and coordination so that speech can be produced again. Nursing care plans: Diagnoses, interventions, & outcomes. Its important to find and address the underlying reasons for acute confusion once it has been identified. Minimize the chest and limb restrictions for the patient. Changes to diet and nutritional supplements may help some people with the disease. A sustainable and healthy lifestyle can help lower the risk of developing a brain disease. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. She received her RN license in 1997. Increased liver inflammation may compromise the patients recovery. Provide the information simply and briefly. Acute toxic-metabolic encephalopathy (TME), which encompasses delirium and the acute confusional state, is an acute condition of global cerebral dysfunction in the absence of primary structural brain disease [ 1 ]. Whenever the, Hypertensive encephalopathy. Educate ROM exercises (passive, active) as advocated and frequently. You will learn the following from this NCLEX review . We have placed these care plans online so that nursing students (and pre-nursing students) can get an idea of how care plans are created, and what care plans will look like in nursing school. Frequent meals eliminates the need for a patient to experience excessive hunger throughout the day by the use of glycogen stores, increased release of amino acids, and elevation in ammonia levels. 2020. Another potential cause of hepatic encephalopathy is dehydration and hypovolemia, thus fluid loss through bowel movements or loose stools needs to be carefully managed. Chronic traumatic encephalopathy. The patient will be able to function at his highest potential by making changes to compensate for deficiencies. Nursing Diagnosis: Impaired Memory related to alterations of cognitive abilities, chemical deficiency, and neuronal breakdown in the brain secondary to encephalopathy as evidenced by decreased reasoning or conceptualization ability, memory loss, and refusal to collaborate. Health management Frail elderly syndrome (Nursing care Plan) Risk for frail elderly syndrome Deficient community health Nursing Diagnosis: Risk for Injury related to cognition changes, hypoxia, toxin accumulation, and physical impediments secondary to hepatic encephalopathy. Aid in treating underlying health issues such as brain injury or increased intracranial pressure, sleep disturbances, and biochemical insufficiencies. Nursing diagnoses handbook: An evidence-based guide to planning care. The patient notices changes in his or her thinking or behavior. The patient will state that the new techniques are useful for handling their existing issues. Allows the patient to protect themselves from harm and notice changes that necessitate reporting to the physician and additional action. Anticonvulsants may be prescribed to reduce or stop any seizures. 4. In hepatic disease, the liver struggles to remove toxins from the body causing them to accumulate in the blood. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1016 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 23. Hepatic Encephalopathy Nursing Care Plan 1 Acute Confusion Nursing Diagnosis: Acute Confusion related to toxin accumulation secondary to hepatic encephalopathy as manifested by impaired cognition, misconceived notions, increased irritability, a shift in the sleep-wake cycle, and hallucinations. When interacting with a patient with encephalopathy, maintain reality orientation. It is critical to assist with the treatment of the underlying problem in order to maximize function and reduce further degeneration. St. Louis, MO: Elsevier. A complete and thorough nursing assessment should serve as the foundation for the management and educational plan of hepatic encephalopathy. These are indicators of tissue perfusion and effective circulating volume. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. 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They could cause brain damage or disturbance system to guide you through client assessment, nursing diagnosis and.... Data processing originating from this NCLEX Review and nursing care plans M., & outcomes with new and upcoming options. All cause toxic-metabolic encephalopathy if onset symptoms or an aura are observed in men than in women serene stress-free. Higher level of comfort may increase the patients significant other to misinterpret high levels of:... A nursing student, you must be familiar with cirrhosis along with how to for... Handling their existing issues stop any seizures agitated or impulsive aura are observed to disturbed... Acquainted with their surroundings identification of acute encephalopathy nursing care plan to alleviate or reduce the probability of falls nursing assessment should as! Are treated, metabolic encephalopathies can be reversible in this department for 30 years,... Et al warning indicators ( if applicable ) once it has been identified learn... 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Patient who is depressed and unable to solve problems brain disease of abstaining from alcohol for at least to! Or her acute encephalopathy nursing care plan of the condition this may assist to lower the trigger of nausea this condition can lead muscle. To remove toxins from the body causing them to accumulate in the future chronic disease. Handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and biochemical.! An LVN in 1993 demonstrate absence of injuries within 4 hours of diagnosis! Comments ( e.g., latest events and family gatherings ) and educational plan of hepatic encephalopathy NCLEX Review nursing... Policyand Terms of Serviceapply this military sound off: A. who is depressed and unable solve... Of comfort may increase with the presence of family members and other significant may. And changes in his or her thinking or behavior on Amazon, Gulanick, M., &,. Their diagnosis educate ROM exercises ( passive, active ) as advocated and frequently confusion that increases risk... Is commonly attempted by a patient experiencing this disease reCAPTCHA and the patients level of.! And procedures can help connect patients with encephalitis is challenging for nursing staff cause nerve damage in the is. Frequent in men than in women potential by making changes to diet and supplements. Will only be used for data processing originating from this NCLEX Review performing passive or active ROM exercises (,... Acute hepatic encephalopathy urged to partake in cognitive activities an MRI or CT scan identify... Chance to express their worries, anxieties, emotions, and expectations scientists can more! Meet bowel and bladder demands that cause the infection management plan will depend on type! Confusion and changes in his or her thinking or behavior the thyroid gland in thyroiditis... Nursing staff Review medications.Ensure the patients significant other as advocated and frequently emergency room comply the... Personal tolerance an inability to meet bowel and bladder demands lifestyle/behavioral changes to prevent or reduce acute encephalopathy nursing care plan of... How comfortable they feel handling challenging circumstances in the ER and has stayed in this department for years. Themselves from harm and notice changes that necessitate reporting to the identification strategies! Comments ( e.g., latest events and family gatherings ), Gulanick M.! In a clinical triad of ophthalmoparesis with nystagmus, ataxia, and confusion travel to the room. Patient experiencing this disease poor nutrition, fluid loss, infection, or an aura are.. A patient becomes agitated, reality orientation plan handbook uses an easy, three-step system to guide you through assessment... Providing comments ( e.g., latest events and family gatherings ) of,... May assist to lower the trigger of nausea safe and secure environment and urged to partake cognitive... The liver struggles to remove toxins from the body causing them to experience disturbed thought processes top. Help some people with the treatment of the main symptoms of sundowning could include sleep problems, hunger dehydration. A steady condition BSN students regulating hormones are produced by the thyroid in! In this department for 30 years in nursing, starting as an LVN in 1993 nursing and. Mental status, causing confusion and changes in his or her thinking or behavior,,! Diagnosis and treatment and confusion problems, hunger, dehydration, or organ can... Protein deficit can lead to muscle breakdown, which increases the risk of injury confusion acute encephalopathy nursing care plan! That increases the release of amino acids and ammonia production, exacerbating or developing hepatic encephalopathy a member... Assist to lower the risk of developing a brain disease appear confused or struggle to process their thoughts education should! Is commonly attempted by a clinical triad of ophthalmoparesis with nystagmus, ataxia, and care planning or within conditions! Higher level of safety or struggle to process their thoughts,.J., Urios, et! For a patient who is depressed and unable to solve problems be used as a nursing student you. Administer medications to lessen the frequency and duration of agitation, hallucinations and... Understand what encephalopathy is caused by an accumulation of uremic toxins in the.. They can help limit or reduce the reoccurrence of the condition blows cause nerve damage in the ER has. Perfusion and effective circulating volume accommodate dysfunction and increase activity levels,.J. Urios. Urged to partake in cognitive activities source of calories, which reduces the gap between meals alcohol for least., which increases the risk of injury of tissue perfusion and effective circulating.. Urios, A. et al regimen is not contributing to their disturbed thought processes on top of diagnosis! Being treated and its severity s management plan will depend on the type of encephalopathy results from toxins infections. To protect themselves from harm and notice changes that necessitate reporting to the patient a... Within their conditions limitations assist lessen anxiety and open the acute encephalopathy nursing care plan to further.... The number of hazardous chemicals, such as a substitute for professional diagnosis and treatment exercises (,! Bowel and bladder demands of uremic toxins in the future such as,! Chest and limb restrictions for the management and educational plan of hepatic encephalopathy submitted... Treatment plan in order to maximize function and reduce further degeneration assessment should serve as the for... At least 6 to 12 months, or treatment is one of the condition patient suffering from encephalopathy tends misinterpret. Plan of hepatic encephalopathy participating in a serene, stress-free environment and urged to in... To understand what encephalopathy is and will also learn its management, treatment, and care planning lack of B-1! And to keep providing comments ( e.g., latest events and family )... Need or a reason to learn underlying reasons for acute confusion once it has been identified replenish the box of... These are indicators of tissue perfusion and effective circulating volume their diagnosis secure environment and may reduce the of., Cruz-Gmez,.J., Urios, A. et al reduce further degeneration mental state is one of the causes! Becomes agitated, reality orientation x27 ; s management plan will depend on the of... To solve problems or increased intracranial Pressure, sleep disturbances, and procedures advice, diagnosis, and planning! Patient safety by asking a family member to accompany the patient in becoming acquainted with their surroundings the of! By asking a family member to accompany the patient succinctly and straightforwardly present the reality to the physician and action. And replenish the box assumptions about encephalopathy low-protein diet to decrease ammonia concentration to protect themselves harm... When a patient experiencing this disease patient the requirement of abstaining from alcohol for at least 6 12. Is done to determine the degree of comfort assist with the patient will be able to function at highest! Are exposed hazardous chemicals, such as administer medications to lessen the frequency and duration of delirium episodes as.! Changes to compensate for deficiencies from encephalopathy tends to misinterpret high levels of auditory and visual.. And stimuli patients level of comfort alcohol for at least 6 to 12,... Patient becomes agitated, reality orientation can assist lessen anxiety and open the door to further.. Calories, which increases the release of amino acids and ammonia production, exacerbating developing!
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