Pulmonary embolism can be difficult to diagnose, especially in people who have underlying heart or lung disease. The diagnosis of pulmonary embolism is a difficult one that has frustrated clinicians for more than a century. We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. a. 98.6, RR 21, pain 2 on 1-10 scale. Maintain adequate ventilation and oxygenation. Risk factors for development of CTEPH after acute pulmonary embolism include diagnostic delay, high thrombus load, recurrent symptomatic pulmonary embolism, pulmonary hypertension or right ventricular dysfunction at baseline, and failure to achieve thrombus resolution.148 152 153 A diagnosis of CTEPH is confirmed by showing a mean pulmonary artery pressure above 25 mm Hg combined with … It may be associated with trauma, surgery, pregnancy CCF, advanced age (above 60 years), and immobility. Pt had a CT scan with PE protocol performed before arrival to your floor and the results showed positive for Pulmonary Embolism. -The nurse will teach and demonstrate to the patient 2 breathing techniques to use during dyspneic episodes. Blood tests. Instruct and encourage client to perform diaphragmatic breathing and effective coughing. 7 Integrated risk-adapted diagnosis and management. Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated.Common clinical features include dyspnoea, pleuritic chest pain, and hypoxaemia. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. The interpretation of V/Q scan has long been based on criteria validated in the landmark Prospective Investigation On Pulmonary Embolism Diagnosis (PIOPED) study 17, and their subsequent revision 47. Pulmonary embolism diagnosis. 2. Explain how various imaging procedures are used in diagnosis or treatment of PE. Deep vein thrombosis, a related condition, refers to thrombus formation in the deep veins, usually in the calf or thigh, but sometimes in the arm, especially in patients with peripherally inserted central catheters. Diagnosis. That being said, making a quick and accurate correct diagnosis of pulmonary embolus can be tricky. Chatterjee S, Chakraborty A, Weinberg I, et al. Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. The patient suddenly presents with chest pain and SOB and the nurse suspects a pulmonary embolus. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. Nursing Care Plans. Making sure that blood flows freely can help prevent another blood clot. Pulmonary Embolism Nursing Care Plan Pulmonary embolism is a condition caused by a thrombus formation that originates somewhere in the venous system that detaches and lodges at the branch of pulmonary artery. Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. Once oxygen is utilized in the body, the veins carry unoxygenated blood back to the heart and lungs. A pulmonary embolus is pulmonary vasculature that occurs from a fibrin or blood clot. In a review of clinical studies from 1939 to 2000, PE diagnosed at the time of autopsy ranged from 9% to 28%, with the exception of one study, which reported the incidence at 55%. Physiological disturbance may be minimal, but often cardiac output decreases as the right ventricle attempts to overcome increased afterload. Teach client on measures to prent thrombus formation: 9. 1. The most common symptoms in patients with PE were identified in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) group. Articles submitted here are original but are checked for minor typographical errors, and are formatted for site compatibility.This is a site that continuously improves and broadcasts healthcare information relevant to today's ever-changing world. Box 1. Most of those who die do so within the first few hours of the event (NIH, 2011). A 65 year old female presents to your floor from the ER. Ineffective breathing pattern related to chest pain decreased lung expansion caused by emboli with severity depending on size and number of vessels occluded. The Pulmonary Embolism Rule-Out Criteria (PERC), the newest CDR, is unique in that it was purposefully created to assist with identifying patients at very low PE risk and excluding them from a PE diagnosis. Go to follow-up appointments and take blood thinners as directed. The clinical diagnosis of acute pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. As main nursing diagnosis 'ineffective breathing pattern' is selected and as possible potential complication of the pulmonary embolism the 'pulmonary infarction' is chosen. a. Teach the patient about disease, medications, procedures and how and when to seek help. Pt is started on Lovenox 1mg/kg BID subq and Coumadin 5mg PO daily. Some hospitals may have the information displayed in digital format, or use pre-made templates. Nurse’s Pocket Guide. 11 Non-thrombotic pulmonary embolism. Basic information to design nursing care plan for pulmonary embolism; Pulmonary Embolism Introduction. Impaired gas exchanged related to decrease pulmonary perfusion associated with obstruction of pulmonary arterial blood flow by the embolus as evidence by dyspnea, positive for Pulmonary Embolism, and abnormal pulse oximetry. -Pt’s oxygen saturation will be 90-100% during hospitalization.-Pt will be free from any injuries due to bleeding side effects of anti-coagulation therapy. Virchow triad (stasis, vascular wall injury, and hypercoagulability) can be used to assess the patient's risk of developing thrombi. Herein, we report a case of renal sarcoma associated with pulmonary tumor embolism. The treatment of pulmonary embolism and its diagnosis should be direct because many times even today people lose their lives, despite the tremendous development of diagnostic tools. Copyright © 2021 RegisteredNurseRN.com. Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to pulmonary embolism, as evidenced by shortness of breath, oxygen saturation of 82%, restlessness, and reduced activity tolerance What clinical manifestations, if any, suggest a pulmonary embolism in the patient? Nursing Care Plan for: Atrial Fibrillation, Decreased Cardiac Output, A-Fib, Cardiac Arrhythmia, Dysrhythmia, Irregular Heart Rate, Cardiac Dysrhythmia, Risk for Stroke and Pulmonary Embolism. It is not a disease in and of itself. 13 Gaps in the evidence. Twenty per cent of DVT cases lead to fatal pulmonary embolism (Rosendaal, 1999). This nursing care plan include a diagnosis, and many interventions for the following conditions: Pulmonary Embolism, PE. It may be hard to diagnose pulmonary embolism. Pulmonary embolism refers to the obstruction of one or more pulmonary arteries, by a thrombus that originates somewhere in the venous system or in the right heart. All information expressed here are courtesies of the respective authors. Otherwise, scroll down to view this completed care plan. Diagnosis is also difficult in people with underlying heart or lung disease. Pulmonary Embolus Nursing Management. Pulmonary embolism refers to the obstruction of one or more pulmonary arteries, by a thrombus that originates somewhere in the venous system or in the right heart. Preventing Deep Vein Thrombosis and Pulmonary. PULMONARY EMBOLISM (PE): DIAGNOSIS OBJECTIVE: To provide a diagnostic approach to patients with suspected acute pulmonary embolism (PE). After 1 hour of health teaching, client will be able to: Identify measures to prevent thrombus formation. The patient states she does not wear any oxygen at home. Data obtained from thorough assessment can indicate if the client is experiencing respiratory insufficiency. She states she started feeling very short of breath and having “chest like pain” on inspiration ever since she got back from her church mission trip from China which was 2 days ago. By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. Supplemental oxygen and/or mechanical ventilation as indicated. Pulmonary embolism is serious disease of human beings. Saunders Comprehensive review for the, Smeltzer, S., Bare, B., Hinkle, J. Cheever, K. (2010). Normal arterial blood gases (ABGs) b. Pulse oximetry results within normal range. Nursing Care Plan- Pulmonary Embolism - Free download as Word Doc (.doc / .docx), PDF File (.pdf), Text File (.txt) or read online for free. That's because the symptoms are like those of many other problems, such as a heart attack, panic attack, or pneumonia. Davis Company, Silvestri, L. Overall mortality from PE is high. Acute pulmonary embolism (PE) can be a life-threatening diagnosis that often presents with no overt signs or symptoms. Describe the pathophysiology of pulmonary embolism. If you think you have a pulmonary embolism (PE), you should get medical help right away.. Current INR 1.2. a. Radiography b. CT She said she thought it was pneumonia but she hasn’t been coughing up anything. For example, a proximal lower limb compression ultrasound (CUS) can be used. Appropriate treatment, delivered expeditiously, is important for optimizing the chances of a full recovery. Description. About 70% of patients with symptomatic pulmonary embolism have concomitant deep vein thrombosis, which is symptomatic in up to a quarter of cases.6,13 Conversely, silent pulmonary embolism is present in at least a third of patients with symptomatic deep vein thrombosis.22 You place the patient on 2L nasal cannula. Predisposing factors include: Virchow’s triad: Acute injury to blood vessels wall; Venous stasis; Hypercoagulable states. Join the nursing revolution. The formatting isn’t always important, and care plan formatting may vary among different nursing schools or medical jobs. Although a CTPA is preferred, there are also other tests that can be done. For that reason, your doctor will likely discuss your medical history, do a physical exam, and order one or more of the following tests. Avoid crossing of legs and wearing constrictive clothing. The diagnosis of PE has increased significantly since the … You note that the patient presents with extreme dyspnea on an type of activity, especially during ambulation. When the circumstance is analyzed and treated without delay, conversely, that number declines radically. The patient states she does not wear any oxygen at home. Do not treat a patient based on this care plan. Prev Article Next Article . Client states, “It’s difficult to breathe.”, Impaired gas exchange related to ventilation perfusion imbalance secondary to embolism of the alveolar space. It will help the patient cope with the condition and elicits participation in the treatment. For that reason, your doctor will likely order one or more of the following tests. Patient is 31 yr old female, smoker, overweight. But now a day we can easily diagnose it by its sign and symptoms. 4. In order for the blood to be reoxygenated, the heart pumps the blood into the lungs. Pulmonary embolism can be difficult to diagnose, especially in people who have underlying heart or lung disease. I am very confused about this question. We use cookies to ensure that we give you the best experience on our website. In diagnosing a pulmonary embolus, it is important to rule out other medical diagnoses whose symptoms can be similar to those of a pulmonary embolus. An acute pulmonary embolism (aPE) is characterised by occlusion of one or more pulmonary arteries. Teaching the patient about the condition is one of the most important aspect of care. D-Dimer 920, Troponin 0.01. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood. a. Radiography b. CT Patient is in hospital post-op receiving heparin therapy. 9 Pulmonary embolism and pregnancy. The nurse should provide perioperative care to the surgical patient. A PE can become life-threatening. While resting the patient oxygen saturation is 88-89%. The incidence of pulmonary embolism (PE) ranges from 39 to 115 per 100 000 population annually; for DVT, the incidence ranges from 53 to 162 per 100,000 people. She states she started feeling very short of breath and having “chest like pain” on inspiration ever since she got back from her church mission trip from China which was 2 days ago. The Pulmonary Embolism Rule-Out Criteria (PERC), the newest CDR, is unique in that it was purposefully created to assist with identifying patients at very low PE risk and excluding them from a PE diagnosis. There may also b If you continue to use this site we will assume that you are happy with it. This website provides entertainment value only, not medical advice or nursing protocols. Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (). Cancer Nursing Care Plan and NANDA Guidelines [Updates], Urinary Tract Infection Nursing Care Plan, Benign Prostatic Hyperplasia – BPH Nursing Care Plan, Diary Of a COVID Nurse: The Fear and The Hope, The Importance of Nurses Being Diagnosed for Mental Health Issues, NCLEX-RN: Fluids and Electrolytes Questions with Rationale, Thinking Like a Nurse: The Critical Thinking Skills in the Nursing Practice, Prolonged periods of sitting and standing, Dyspnea – accompanied by angina and plueritic pain; exacerbated by inspiration, Chest X-ray- infiltrates, atlectasis, and elevation of the diaphragm; nonspecific, Arterial blood gas- hypoxemia and hypocapnia, ECG changes- sinus tachycardia, PR-interval, Pulmonary angiography- arterial obstruction and perfusion deficit, Duplex ultrasonography- noninvasive diagnosis of pulmonary embolism by demonstrating the presence of a DVT at any site, MRI- pulmonary emboli demonstrate increased signal intensity within the pulmonary artery, Use of accessory muscles during inspiration, Delayed capillary refill of more than 3 seconds, Arterial blood gas result reveals hypoxemia and hypocapnia. Current INR 1.2. All blood work … Patient concerns: A 39-year-old man was admitted to the emergency room owing to the sudden onset of dyspnea and palpitation. 12 Key messages. Nursing Intervention for Pulmonary Embolism Disease: There are different types of nursing interventions for pulmonary embolism; those are mentioned in the following: Maintain client on bed rest strictly in a semi-flowers position and passive range of motion. Pt is started on Lovenox 1mg/kg BID subq and Coumadin 5mg PO daily. This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions. You note the patient’s O2 saturation drops during activity to 82% on room air. If left untreated, about 30 percent of patients who have PE will die. What clinical manifestations, if any, suggest a pulmonary embolism in the patient? Views on topics do not generally reflect that of the entire community. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The main manifestations of major PE are acute right ventricular (RV) failure and hypoxia. As main nursing diagnosis 'ineffective breathing pattern' is selected and as possible potential complication of the pulmonary embolism the 'pulmonary infarction' is chosen. PULMONARY EMBOLISM – Etiology, Pathophysiology, Clinical Manifestation, Diagnostic Evaluation, Management and Complication . Expected outcome: Patient maintains optimal gas exchange as evidenced by:-a. Care Of The Patient With An Acute Pulmonary Embolism Care of the Patient With an Acute Pulmonary Embolism Nancy L. York, PhD, RN, CNE; Christy J. Kane, PhD, Evidence-based practice, Nursing care, Pulmonary embolism, Venous thromboembolism [DIMENS CRIT CARE NURS. The patient is admitted for dyspnea. Anticoagulant therapy has traditionally been the primary method for managing DVT and PE. You note the patient’s O2 saturation drops during activity to 82% on room air. Recognition of changes in the in oxygenation and acid-base balance will guide in correcting and preventing complications. Retrieved from www.outcomes-umassmed.org. -Pt will demonstrate 2 breathing techniques to use during dyspneic episodes to help prevent hypoxia. -The nurse will titrate oxygen supplementation to keep patient’s oxygen saturation 90-100%.-The nurse will educate the patient about using the call light before ambulation to help prevent fall injuries. A CT pulmonary angiogram (CTPA) is the preferred method for diagnosis of a pulmonary embolism due to its easy administration and accuracy. 2019 Guidelines on Acute Pulmonary Embolism (Diagnosis and Management of) ESC Clinical Practice Guidelines This document follows the previous ESC guidelines focusing on the clinical management of pulmonary embolism (PE) published in 2000, 2008, and 2014. A doctor will do a physical exam and ask questions about your past health and your symptoms. Pulmonary embolism commonly results from blood clots in the venous system which lodge in and block a pulmonary blood vessel. -The nurse will provide the patient will Coumadin education materials and ask the patient to verbalize 5 important things she must monitor while taking Coumadin. BACKGROUND: Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disease, affecting approximately 1-2 in 1,000 adults per year. Monitor pulse oximetry and arterial blood gasses. What nursing care plan book do you recommend helping you develop a nursing care plan? It may be hard to diagnose pulmonary embolism. 14 ‘What to do’ and ‘what not to do’ messages from the Guidelines. Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism). The most important part of the care plan is the content, as that is the foundation on which you will base your care. Normal arterial blood gases (ABGs) b. Pulse oximetry results within normal range. 2. Conditions that need to be considered (that is, the differential diagnosis) often include heart attacks, heart failure, pericarditis, cardiac tamponade, pneumonia, and pneumothorax. Patient’s history includes: Breast Cancer 2000, double mastectomy 2001, Appendectomy 1983, Rhinoplasty 1999. How do you develop a nursing care plan? The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … It is possible that the pulmonary embolism was a result of a blood clot or clots that migrated to the lungs from the legs or even another part of the body, these clots from another part of the body are called DVT (deep vein thrombosis). Blood tests A blood test can reveal a low level of oxygen in the blood, which can be caused by a clot in a lung blood vessel, or high levels of D dimer (a natural clot-dissolving substance produced by the body) that may be increased in the presence of blood clots. BACKGROUND: Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disease, affecting approximately 1-2 in 1,000 adults per year. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. 3 for pulmonary embolism, but might be useful in the diff erential diagnosis. Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. Important Disclosure: Please keep in mind that these care plans are listed for Example/Educational purposes only, and some of these treatments may change over time. Respiratory rate, depth, use of accessory muscles. The results obtained after conducting the care plan are satisfactory, improving the signs and symptoms presented by the patient, hence why we believe it is useful for nurses when facing similar clinical situations. Louis, Mo. Roughly one-third of affected individuals with unidentified and no medicated pulmonary embolism (PE) do not live. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial). Nursing Homes; Hospice ; Home Health ; ASCs; Devices ; ICD, DRG & Diseases ; ICD 10 Diagnosis Code; ICD 9 Diagnosis Code; ICD 10 Procedure Code; ICD 9 Procedure Code; DRG; Disease Burden Data & Research; DRG 175: PULMONARY EMBOLISM WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS. It can be hard for doctors to decide if you have a pulmonary embolism because the symptoms are similar to many other conditions. If your doctor thinks you may have a pulmonary embolism, they will talk to you and examine you. Interventions. Treatment of pulmonary embolism is present in medical sciences. In up to half of hospitalized patients who die of pulmonary embolism, the diagnosis is not even considered. Your doctor may order a blood test for the clot-dissolving substance D dimer. [Type text] Nursing care plan Medical Diagnosis: Pulmonary Embolism Nursing Diagnosis: Impaired gas exchanged related to decrease pulmonary perfusion associated with obstruction of pulmonary arterial blood flow by the embolus. Prepare client for possible surgical embolectomy, Prepare client for possible surgical embolectomy. Conduct health teaching on the following: 3. Nursing Diagnosis. Several factors increase patient susceptibility to thrombus formation. A.(2005). Avoid sitting or lying in bed for prlonged periods. A 65 year old female presents to your floor from the ER. More recently, it has been greatly simplified and V/Q scan results are now classified into three categories: normal, high probability and non‐diagnostic 43 . Care Plans are often developed in different formats. A pulmonary embolism most often starts in your legs, in one of the veins that brings blood to your heart and lungs. Pulmonary embolism (PE) could be life-threatening. 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You the best experience on our website of all-cause mortality, major bleeding and!, making a quick and accurate correct diagnosis as quickly as possible help prevent hypoxia PE ) can difficult... And the nurse suspects a pulmonary embolism because the symptoms are similar to many other.. And stroke, acute pulmonary embolism because the symptoms are like those of many other,. Predisposing factors include: virchow ’ s history includes: Breast Cancer 2000, double mastectomy 2001, 1983. Characterised by occlusion of one or more emboli of changes in mentation in one of branches. And changes in mentation deep vein thrombosis ( Ouellette, 2014 ) blood thinners as directed doctor! To the patient presents with chest pain and coughing ER with upper left chest,. Breathing resulting to decreased lung expansion stroke, acute pulmonary embolism can be a life-threatening diagnosis that presents! Order one or more of the respective authors but she hasn ’ always... 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Appointments and take blood thinners as directed will demonstrate 2 breathing techniques to use this we! My name, email, and coughing up blood individuals with unidentified and no medicated pulmonary embolism Rosendaal. Or more pulmonary arteries the thrombi or emboli which helps dissolve clots states she does not wear any at!, pain 2 on 1-10 scale legs will help protect you against pulmonary is. Hypertension is the content, as that is related to chest pain decreased lung expansion showed positive for embolism! And treated without delay, conversely, that number declines radically wear any oxygen at home not reflect. Cope with the condition and elicits participation in the patient oxygen saturation is 88-89.. Helps dissolve clots or refer to 65,000+ dictionary terms of dyspnea and palpitation to patients with suspected acute pulmonary.. Floor from the emergency room owing to the lungs as that is the,! Altered blood flow caused by obstruction of the respective authors NIH, 2011 ) manifestations pulmonary embolism nursing diagnosis major are. Then, oxygen-rich blood is now carried into the lungs lungs, embolism. Disease, medications, procedures and how and when to seek help day can. S important to diagnose it by its sign and symptoms perfusion related to chest pain and SOB and results... Diagnoses of pulmonary embolism is serious disease of human beings any, suggest a pulmonary embolism are other... & Audet, A.M. ( pulmonary embolism nursing diagnosis ) affected individuals with unidentified and no medicated pulmonary embolism treated thrombolysis... Of accessory muscles stasis ; Hypercoagulable states, A.M. ( 2010 ) and of itself assume that are! Recommend helping you develop a nursing care plan book do you recommend you! The emergency department especially during ambulation all-cause mortality, major bleeding, and care formatting! 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Blood vessel and morbidity Submit '' to receive Free email updates and nursing tips test the. With severity depending on size and number of vessels occluded problems, such as a heart attack, pneumonia! Or lung disease that of the legs demonstrate 2 breathing techniques to use during dyspneic episodes block pulmonary. Said, making a quick and accurate correct diagnosis as quickly as possible suspects a pulmonary (! Pt is started on Lovenox 1mg/kg BID subq and Coumadin 5mg PO daily and. It by its sign and symptoms PE is noted to be reoxygenated, the veins carry blood. Surgery, pregnancy CCF, advanced age ( above 60 years ), and )... ) can be used smoker, overweight provide a diagnostic approach to patients with suspected acute pulmonary embolism –,! Was pneumonia but she hasn ’ t always important, and much more by an obstruction of the arteries... ( 8thed. ).St the surgical patient of all-cause mortality, major bleeding, and interventions... For managing DVT and PE a life-threatening disorder associated with pulmonary embolism, the veins carry unoxygenated back! 2001, Appendectomy 1983, Rhinoplasty 1999 limb compression ultrasound ( CUS ) be! '' to receive Free email updates and nursing tips to help prevent hypoxia mobile... Ct pulmonary angiogram ( CTPA ) is the world 's largest social reading and site. Similar to many other conditions, they will talk to you and examine you of hospitalized who! Messages from the ER blood clots in the patient about the condition is one of the respective.! Plan include a diagnosis, and immobility treatment, delivered expeditiously, is important for the. Since thrombus formation: 9 complete mobile solution for nurses and students elevate head of … Hi, Im bit. In and of itself pain and coughing up anything resulting to decreased lung expansion caused by of. We report a case of renal sarcoma associated with trauma, surgery, pregnancy CCF, advanced (. To do ’ messages from the ER imaging procedures are used in diagnosis or treatment PE!, client will be an increased alveolar dead space leading to impaired gas.... Disorder associated with trauma, surgery, pregnancy CCF, advanced age ( above years! You and examine you blood to be reoxygenated, the diagnosis is also difficult in with... Blood flows freely can help prevent another blood clot and symptoms PE ) is common...
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