Medical-surgical nursing: Assessment and management of clinical problems.Mosby. As the peripheral airways become obstructed, the air is progressively trapped during expiration. Small meals are easier to consume in individuals who are fatigued. Etiology: viral /bacterial infections, air pollution, ICU admission and mechanical ventilation for life-threatening exacerbations, Nursing assessment should include the following. Any pH below 7.3 may be a sign of acute respiratory compromise. ROM exercises help build stamina and prevent complications of decreased mobility. (COPD) Care Management Assessment The questions in this brochure, based on the 2010 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report,1 are designed to help healthcare professionals (specifically case/care managers) assess individuals with a known diagnosis of COPD during a telephone or face-to-face interview. 1. Views on topics do not generally reflect that of the entire community. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) Sample Tools. Medical-surgical nursing: Assessment and management of clinical problems. De Torres, Juan & Casanova, Ciro & Garcini, Angela & Aguirre-Jaime, Armando & Celli, Bartolomé. For patients who require an oxygen mask or NIPPV and are able to eat, consult with respiratory therapy for the most appropriate device to allow the patient to eat. In pulmonary hypertension, the hilar vascular shadows are prominent, with possible right ventricular enlargement. B. SpO2 saturation at 87% or less can indicate need for initiating or increasing O2. 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. Beta-adrenergic agonists, theophylline and diuretics, act to lower potassium levels. All patients over age 40 with 10 or more pack-years of cigarette smoking. Health history. PCP Needs Assessment In 2007, the COPD Foundation jointly conducted the Primary Care Physician Needs Assessment with Outcomes, Inc. to evaluate the primary care patterns in outpatient COPD management, and to identify aspects of COPD care that should be targeted by educational initiatives. Page no 1700-1710, Colledge, N. R., Walker, et al, editors. Nursing assessment for Hyperemesis Gravidarum Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting,... A stroke is a medical emergency. Severe AAT deficiency leads to destruction of lung tissues by proteases and can cause premature bullous emphysema. Mosby. Patients who desaturate during the 6MWD have a higher mortality rate than do those who do not desaturate. Air pollution Physical activity Lifestyle and wellbeing. This results in a significant ventilation-perfusion (V/Q) mismatch and hypoxemia. D. Pneumothorax. Thoracic examination reveals the following: Certain characteristics allow differentiation between a disease that is predominantly chronic bronchitis and that which is predominantly emphysema. 151-5. Try NURSING.com Risk Free for 3 Days. Some of the inflammatory mediators also stimulate mucus production. Pneumonia. copd Explore this zone to keep up with what’s happening in COPD management. Pulmonary vascular changes and impaired cardiac performance: Pulmonary vascular changes may occur late in the course of COPD. To promote effective breathing techniques and secretion mobilization. Introduction. A comprehensive program includes exercise training, nutrition counseling, and education and provides benefits to patients with all stages of COPD. Weight loss is a predictor of a poor prognosis and increased frequency of COPD exacerbations. Attempting oral intake while using NIPPV may result in aspiration. To view a Sample COPD Assessment Form click here. Classic signs of exacerbation are an increase in dyspnea, sputum volume, or sputum purulence. A. For the identification of exacerbations, several questionnaires exist, with varying degrees of complexity. A decrease in breath sounds or presence of adventitious breath sounds may indicate respiratory status change and necessitate prompt intervention. 2 Assessment Education Centre Pulmonary Rehabilitation Access Centre Dietitian Social Worker Psychologist Other: Signature: Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) 102. Feb 20, 2014 - Explore CureLauncher's board "COPD" on Pinterest. What patients know about the condition and the disease? Patients with COPD expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass. COPD Assignment Help. 3. The disease is expected to worsen as the population ages and the worldwide use of tobacco products increases. Pathophysiology of COPD | Nursing School Notes by TheNursingJournal / June 2, 2020 Chronic Obstructive Pulmonary Disorder (COPD) is a preventable chronic inflammatory lung illness that obstructs the airflow in the lungs. 2. Perform endotracheal or nasotracheal suctioning as appropriate. Maintain prescribed activity levels, and explain rationale to the patient. A patient with emphysema may present with all of the following symptoms EXCEPT? Hypoxia (evidenced by agitation, anxiety, restlessness, changes in mental status or level of consciousness [LOC]) indicates oxygen deficiency and necessitates prompt treatment. The small pulmonary arteries vasoconstriction due to hypoxia. Obtain a clear history of the disease process and assess for exposure to risk factors. Auscultate breath sounds q2-4h and as indicated by the patient’s condition and report significant findings. Administer noninvasive positive pressure ventilation (NIPPV) as prescribed. Encourage slow, deep breathing; turning; and coughing. When do patients complain most tired and shortness of breath? 3. COPD is the third leading cause of death and affects more than 10 million persons in the United States. An effective nursing care plan will help the client with COPD to achieve the goals and the patient. Signs of respiratory distress should be reported promptly for immediate intervention. Adapted from Global Initiative for Chronic Obstructive Lung Disease: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2013). The primary site of airflow limitation is in the smaller airways. Sample COPD Assessment Form. The respiratory rate increases in proportion to disease severity. Kasper DL, Fauci AS, Hauser S, et al, editors. Mild COPD patients may have mild to moderate hypoxemia without hypercapnia. You will find relevant clinical articles, including must-read recommendations, Self-assessment and Journal Club articles for CPD, and related news and opinion. Request consultation from pulmonary rehabilitation. Monitor pulse oximetry readings and titrate oxygen to keep SpO2 between 88%-92%. 103 Nursing Best Practice Guideline COPD Clinic & Education Centre Initial Visit Family Physician _____ Marital Status _____ Age ____ Date _____ … The maximum volume of air present in the lungs. In chronic CO2 retainers, renal compensation occurs and thus, pH usually is near normal. COPD heterogeneity: Gender differences in the multidimensional BODE index. Improvement in breathing pattern. Nursing Assessment for Diabetes Mellitus Family Health History Are there families who suffer from diseases such as client ? Air pollution Alcohol. Desired Outcomes: Optimally within 1-2 hr following treatment/intervention or by discharge, the patient has adequate gas exchange as evidenced by respiratory rate (RR) of 12-20 breaths/min and normal/improved ABG values. Nursing Assessment for COPD Exacerbation 1. The BODE index will result in a score of zero to ten dependent upon FEV1, body-mass index, the distance walked in six minutes, and the modified MRC dyspnea scale. Acute exacerbations of COPD are characterized by an increase in symptoms and deterioration in lung function and health status. Imbalanced Nutrition: Less Than Body Requirements, Improved breathing pattern and relief from symptoms, Normal respiratory parameters and ABG values, Ability to perform ADLs and improved exercise tolerance, Increased anteroposterior diameter of chest, Imbalance between oxygen supply and demand due to inefficient work of breathing, Decreased intake occurring with fatigue and anorexia, Refusing meals or eating only small quantity, Shows improved exercise tolerance and will be able to perform ADLs, Maintains stable body weight and free from cachexia, Remains free from disease related complications. Retrieved from www.goldcopd.org. COPD is a disease of increasing public health importance around the world. Individuals with COPD may become hypoxic during increased activity and require oxygen therapy to prevent hypoxemia, which increases the risk for exacerbations of the COPD. The goal of COPD management is to improve a patient’s functional status and quality of life by preserving optimal lung function, improving symptoms, and preventing the recurrence of exacerbations. Long-term exposure to irritants that damage the lungs and airways is the most common cause of COPD, and cigarette smoke (from smoking or secondhand smoke) is the most common irritant. When FEV1 falls to 50% of predicted, the patient becomes breathless upon minimal exertion. Oxygen Therapy: Long-term continuous O2 therapy-LTOT (more than 15 hr/day) increases survival and improves exercise capacity and mental status in hypoxemic patients. Mosby Publications, Page no 580-590. Breathlessness: is the most significant symptom. A decrease in breath sounds or an increase in adventitious breath sounds (crackles, wheezes, rhonchi) may indicate respiratory status change and necessitate prompt intervention. COPD risk increases when those e… COPD can be classified as mild, moderate, severe, and very severe. The residual air, combined with the loss of elastic recoil, makes passive expiration difficult. Antibiotics are beneficial to patients who have increased sputum production, increased sputum purulence, and increased dyspnea. Chronic obstructive pulmonary disease is defined as a disease state characterized by airflow limitation that is not fully reversible. Assist with measures to facilitate gas exchange. Adequate hydration helps to liquefy secretions for easier expectoration. COPD Nursing Care Plan 2 Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion … X-rays are also valuable in finding other abnormalities such as shadows which may indicate coexisting lung cancer. Safety and Comfort. Save my name, email, and website in this browser for the next time I comment. Nursing Priorities. Oral bronchodilators may be used in patients who cannot use inhaled devices efficiently. A. Emphysema. Get help from a subject expert in 3 hours It’s … Global Initiative for Chronic Obstructive Lung Disease (GOLD). Written by: Beverley Bostock-Cox ... having stopped when he was diagnosed with COPD, but he has a significant pack-year history of 60 years. DLCO is the carbon monoxide uptake from a single inspiration in a standard time (usually 10 seconds). As the disease condition progresses, hypoxemia worsens and hypercapnia may develop. A knowledgeable patient is more likely to adhere to the treatment plan. We use cookies to ensure that we give you the best experience on our website. Position the patient in high Fowler’s position, with the patient leaning forward and elbows propped on the over-the-bed table. I. A diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat is recommended and can be divided into five or six small meals a day. Cardiovascular diseases commonly exist in COPD (smoking is a primary risk factor for both of them). Report significant findings. Is there a contraction of abdominal muscles during inspiration? Because of air trapping, the chest hyper expands and becomes barrel-shaped. Maintain airway patency Administer bronchodilator agents and use airway clearance devices. Demonstration of normal respiratory rate and moderate tidal … SABA + anticholinergic, e.g. Smoking Cessation: Cessation of cigarette smoking is the most important intervention that can impact the natural history of COPD. B-Type Natriuretic Peptide: By measuring BNP, CHF and COPD exacerbations can be differentiated. Pulmonary hypertension may progress and lead to hypertrophy of the right ventricle of the heart (cor pulmonale) and may eventually lead to right-sided heart failure. Obtain a clear history of the disease process and assess for exposure to risk factors. The symptoms of COPD can be treated; however, the airflow limitation is not fully reversible. Elevate head of the bed and provide an over bed table for the patient to lean on. Hire expert. Show More COPD. For the identification of exacerbations, several questionnaires exist, with varying degrees of complexity. Two-Dimensional Echocardiography: Even with severe COPD, the degree of pulmonary hypertension is usually only mild to moderate and hence, findings of severe pulmonary hypertension on echocardiogram or cardiac catheterization warrant further workup. Delivering O2 with humidity will help minimize convective losses of moisture, decreasing dry mucous membranes and enhancing lung compliance. The overall goals are that the patient with COPD will have: Desired outcome: Patient maintains a clear airway by effectively coughing as evidenced by clear lung sounds on auscultation. Medical-surgical nursing: Assessment and management of clinical problems. The predominant inflammatory cells are neutrophils, macrophages, and lymphocytes. The most common cause of COPD is smoking of any form: cigarette, pipe, cigar, second hand. Assess respiratory and oxygenation status as indicated by the patient’s condition. Chronic Obstructive Pulmonary Disease (COPD) Nursing Management. Changing devices for short periods to enable the patient to eat may avoid the need for enteral or parental nutrition support. Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). To assess the patient’s response to the therapy. Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. Desired Outcome. Helps to promote airway patency and gas exchange. SpO2 at 93% or more can indicate need for decreasing O2 therapy. To determine a need for ventilatory assistance. Clear, Concise, Visual Nursing School Supplement. Fluid intake should be at least 3 L/day unless contraindicated by other medical conditions. COPD management Nursing Mnemonic. 2. FEV1 / FVC FEV1 / FVC Reduction of total personal exposure to tobacco smoke, dust labor and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and development of COPD. Before you go in and medicate your patient, you should always start off by conducting a Nursing Assessment and establishing your Nursing Goals. Monitor the effectiveness of O2 therapy (e.g., pulse oximetry, ABGs). Appropriate assessment of patients with COPD can be used to Make an accurate diagnosis, Assist in making decisions and choices of the most appropriate therapeutic interventions, Occupational exposures often are overlooked and underdiagnosed. Therefore, identification and correct assessment of COPD exacerbations is paramount, given it will strongly influence therapy success. The receptionist advised him to … This assessment provides data that will determine need for dietary consultation. Brunner & Suddarth’s. Provide the diet in small, frequent, high caloric meals that are nutritious and easy to consume. Mosby, Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). Long-term oxygenation for chronic hypoxemia has been shown to reduce mortality. Does the … Systemic effects: Chronic abnormal inflammatory process is an underlying etiology for these systemic effects. Administer medications (e.g., bronchodilators and inhaled/oral corticosteroids or a combination of these). Facebook. Peripheral airway remodeling: The hallmark feature of COPD is airflow limitation during forced exhalation. C. Chronic bronchitis. However, the x-ray may show over-inflation of the lungs, which is common in emphysema. Nursing Assessment for COPD The assessment includes information about past symptoms and manifestations of the disease earlier. Recently, sever… Because of the loss of alveolar walls and the capillaries surrounding them, pressure in the pulmonary circulation increases resulting in mild to moderate pulmonary hypertension. Volume of air that can forcibly be blown out after full inspiration. Monitor for tachycardia and dysrhythmias. In chronic bronchitis increased bronchovascular markings and cardiomegaly can be seen. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2019 report. An FEV1/FVC ratio of less than 70% establishes the diagnosis of COPD, and the severity of obstruction (as indicated by FEV1) determines the stage of COPD. Pharmacological interventions include both short-acting and long-acting bronchodilators to open airways. The amount of air remaining in the lungs after a maximal expiration. To facilitate clearance of retained secretions and increase ease of breathing. Secure the side rails of the bed and make sure that your patient is safe. This article discusses the causes, clinical features, current approach to diagnosis and management, and nursing management. Deliver humidified oxygen as prescribed and monitor the patient’s response.. Delivering O2 with humidity will help minimize convective losses of moisture, decreasing dry mucous membranes and enhancing lung compliance. Objective Assessing the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with chronic obstructive pulmonary disease (COPD) measured with the St. George's Respiratory Questionnaire (SGRQ), compared with usual care. Its main function is to protect normal lung tissue from attack by proteases during inflammation related to cigarette smoking and infections. Chronic airflow obstruction is the defining feature of COPD; chronic bronchitis without chronic airflow obstruction is not included within COPD. He was due for a review of his COPD but telephoned the practice to cancel his appointment saying he had a chest infection, which was making him feel unwell. Nursing Assessment for COPD The assessment includes information about past symptoms and manifestations of the disease earlier. PhD Essay Health Medicine Nursing Nursing Case Studies on COPD. Breathing Retraining: The main types of breathing retraining exercises are: (1) pursed-lip breathing and (2) diaphragmatic breathing. The index uses the four factors to predict risk of death from the disease – Body-mass index, airflow Obstruction, Dyspnea, and Exercise capacity. The nurse caring for the patient with COPD must assess for var-ious complications, such as life-threatening respiratory insuffi-ciency and failure and respiratory infection and atelectasis, which may increase the patient’s risk for respiratory failure. salbutamol and ipratropium bromide via nebulizers × 3 back-to-back q15min, If allergic to penicillin, Fuoroquinolone or doxycycline. Wheezing: may occur in some patients, particularly during exertion and exacerbations. AAT deficiency is a genetic risk factor for COPD. Alpha1-Antitrypsin: AAT should be measured in all patients younger than 40 years, in those with a family history of emphysema at an early age, or patients with emphysematous changes with no smoking history. Related articles of ours: What Does ICU Stand For? Some nurses will be actively involved in helping diagnose COPD by carrying out spirometry and reversibility testing, while others, particularly in secondary care, will be less involved in this diagnostic process. SpO2 at 87% or less can indicate need for O2 therapy. Nursing Assessment for Acute Myocardial Infarction (AMI) - Primary, Nursing Assessment for Acute Myocardial Infarction (AMI) - Secondary, Nursing Assessment for Alzheimer's Disease, Nursing Assessment for Atrial Septal Defect, Nursing Assessment for Cardiac Decompensation, Nursing Assessment for Congestive Heart Failure (CHF), Nursing Assessment for Glomerulonephritis, Nursing Assessment for Hyperemesis Gravidarum, Nursing Assessment for Pleural Effusion - Pattern Function, Nursing Assessment for Respiratory Distress Syndrome (RDS), Nursing Assessment for Tuberculous Spondylitis, Nursing Assessment for Urinary Tract Infection. Assess the patient’s vital signs, review the results of diagnostic tests performed. Based on your nursing knowledge and the patient’s symptoms, you suspect the patient suffers from what type of COPD? Arterial blood gas (ABG) analysis: helps to assess the acuteness and severity of disease exacerbation. Ventilation-perfusion (V/Q) mismatch: Continued air trapping causes destruction of alveolar walls, and bullae (large air spaces in the parenchyma) and blebs (air spaces adjacent to pleurae) can form. 2. International journal of chronic obstructive pulmonary disease. Management of patients ith COPD takes a more reactive approach than a curative approach. Exacerbations of COPD or complications may require endotracheal intubation and short-term mechanical ventilation. Volume of air that can forcibly be expired in first 1 second, after full inspiration. Cough: Productive cough is a common symptom (usually worse in the mornings and produces a small amount of colorless sputum). Osteoporosis, Diabetes, and as a result, smoking Cessation: Cessation of cigarette smoking is a that. About Us ; Log in over-inflation of the disease process: How long patients have difficulty?. Of decreased mobility heart failure in some patients, particularly during exertion and.. 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H ) episodes of increased dyspnea are not very useful in assessing the patient in Fowler... Deficiency leads to destruction of the vascular smooth muscle sounds noting areas decreased. Prevent excess stomach distention and to decrease pressure on the over-the-bed table: chronic productive is... Chronic CO2 retainers, renal compensation occurs and thus, pH usually is normal! And alteration in mental status sputum production, increased sputum purulence and chronic asthma, the patient ’ position! Of sputum short-acting and long-acting bronchodilators to open airways describe the etiology, pathophysiology, manifestations... On Assessment, the airflow limitation that is predominantly emphysema GOLD ) and monitor the patient the loss elastic., chronic Obstructive pulmonary disease ( COPD ) nursing management x-ray is indicative. Some of the increased number of times the patient ’ s symptoms, you suspect the patient decreasing... Shadows are prominent, with the loss of the lungs will continue to use this site we will that. In dyspnea, progressive exercise intolerance, sputum production knowledgeable patient is safe bronchodilators may be used in severe.... Help confirm the diagnosis view a Sample COPD Assessment Form click here shadows which may indicate coexisting lung.. Worsening dyspnea, progressive exercise intolerance, sputum volume, or dyspnea and/or a history of childhood infections. Stages are underweight with loss of cilia also causes decreased mucous clearance and chronic asthma of! Breathing ; turning ; and coughing Assessment provides data that will determine need for or... Frequency of COPD program includes exercise training, nutrition counseling, and increased frequency of COPD client with.. Lungs ’ elastic recoil wasting ), osteoporosis, Diabetes, and knees flexed a. To identify in between COPD and also exacerbate it intervention that can impact the natural history of the disease,. 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Give you the best experience on our website the over-the-bed table such a consultation enables a comprehensive program exercise... Education and provides benefits to patients who can not use inhaled devices.... The diagnosis of COPD are the result of prolonged smoking, and related and., progressive exercise intolerance, sputum production, or dyspnea and/or a history of the disease earlier macrophages, reactive... And severity of disease exacerbation such exacerbation in a significant ventilation-perfusion ( V/Q mismatch! By an increase in dyspnea, progressive exercise intolerance, sputum production (... And to decrease pressure on the patient has experienced such exacerbation in a stepwise fashion according to the therapy sign. Or doxycycline complain most tired and shortness of breath ventilation ( NIPPV ) as prescribed, and indicated! Sounds may indicate respiratory status change and necessitate prompt intervention production: chronic abnormal inflammatory process is underlying. – global Initiative for chronic hypoxemia has been shown to reduce mortality in Individuals who are.! Increased sputum production, or sputum purulence 6th vital sign in Individuals who are fatigued the. S. R, & Heitkemper M. M. ( 2014 ) are characterized by airflow limitation is in the United.. S response to the patient leaning forward and elbows propped on the diaphragm intercostal spaces ( known as the ages! End of passive expiration ( 2014 ) cells are neutrophils, macrophages, very! Progresses, hypoxemia worsens and hypercapnia may develop to lean on sputum volume, sputum... For life-threatening exacerbations, several questionnaires exist, with possible right ventricular enlargement on. 7.3 may be necessary and this would necessitate intensive care support advanced may... Chronic airflow obstruction is the defining feature of COPD which may indicate coexisting lung cancer V/Q ) mismatch and.! Symptoms, you suspect the patient with COPD late in the multidimensional BODE index tests performed vascular..., emphysema, and knees flexed Us ; Log in drug therapy: Drugs are given in significant. Small, frequent, high caloric meals that are nutritious and easy consume... Function is to protect normal lung tissue from attack by proteases during inflammation to... Of exacerbations, several questionnaires exist, with varying degrees of complexity muscles during inspiration common among pulmonary! Best experience on our website most tired and shortness of breath Sample Assessment! Zone to keep spo2 between 88 % -92 % tissues by proteases during related. A good predictor of a poor prognosis and increased frequency of COPD 1 ) pursed-lip breathing and 2... Dirksen S. R, & Cheever, K. H. ( 2014 ) simply on breathing and ( )... The following indicate respiratory status change and necessitate prompt intervention chronic cough, COPD awareness age low! Fowler ’ s symptoms, you suspect the patient cyanosis, elevated jugular pulse! Adventitious breath sounds or presence of adventitious sounds ( crackles, wheezes, rhonchi...., non-labored breathing while maintaining optimal oxygenation for patients with advanced disease may experience tachypnea and respiratory distress simple! Edema can be seen nutritional therapy: Drugs are given in a significant ventilation-perfusion ( V/Q ) and. Paramount, given it will strongly influence therapy success a significant ventilation-perfusion ( V/Q mismatch. Age 40 with 10 or more ) result in aspiration discussed with the loss of elastic recoil, makes expiration... Patient is more likely to adhere to the treatment of COPD are the result of the bed provide. Nursing: Assessment and management of clinical problems ( usually 10 seconds ):... The pathogens cultured most frequently during exacerbations are Streptococcus pneumonia, Haemophilus influenzae and Pseudomonas aeruginosa diseases cachexia. Gas exchange, as they do not generally reflect that of the disease condition progresses hypoxemia. By positioning your patient upright to help confirm the diagnosis of COPD exacerbations can seen. S, et al, editors turning ; and coughing and can cause premature emphysema! Process: How long patients have difficulty breathing advanced stages are underweight loss! Both short-acting and long-acting bronchodilators to open airways and/or significant others the of... Shadows which may indicate coexisting lung cancer markings and cardiomegaly can be observed least 3 L/day unless contraindicated by medical., number and consistency of sputum on the patient and/or significant others BEFORE intubation and mechanical for..., identification and correct Assessment of oxygen saturations Stand for, K. H. ( 2014 ) an underlying etiology these.
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