NUR 216F 54

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  1. Musculoskeletal trauma accounts for about AAA of all injuries
    two thirds
  2. A AAA fracture occurs after minimal trauma to a bone that has been weakened by disease.
    pathologic (spontaneous)
  3. A AAA fracture results from excessive strain and stress on the bone.
    fatigue (stress)
  4. Stages of bone healing
    • 1. Hematoma
    • 2. Granulation tissue
    • 3. Callus
    • 4. Osteoblastic proliferation
    • 5. Bone remodeling
    • 6. Bone healing completed
  5. For bone fractures: Within 24 to 72 hours after the injury, a AAA forms at the site of the fracturebecause bone is extremely vascular
  6. For bone fractures: in 3 days to 2 weeks when AAA begins to invade the BBB. This then prompts the formation of CCC, providing the foundation for bone healing.
    • A) granulation tissue
    • B) hematoma
    • C) fibrocartilage
  7. For bone fractures: This stage of bone healing occurs as a result of vascular and cellular proliferation. The fracture site is surrounded by new vascular tissue known as AAA. AAA formation is the beginning of a BBB union.
    • A) a callus (within 2 to 6 weeks)
    • B) nonbony
  8. For bone fractures: the AAA is gradually BBB into bone. This stage may take CCC.
    • A) callus
    • B) resorbed and transformed
    • C) 3 weeks to 6 months
  9. For bone fractures: AAA of bone continue to meet mechanical demands. This process may start as early as BBB after fracture and can continue for CCC, depending on the severity of the injury
    • A) consolidation and remodeling
    • B) 4 to 6 weeks
    • C) up to 1 year
  10. In young, healthy adult bone, healing takes about AAA. In the older person who has reduced bone mass, healing time is lengthened. Complete healing often takes BBB or longer.
    • A) 4 to 6 weeks
    • B) 3 to 6 months
  11. AAA is an inelastic tissue that surrounds groups of muscles, blood vessels, and nerves in the body.
  12. The most common sites for this problem in patients with musculoskeletal trauma are the compartments in the AAA and BBB.
    • A) lower leg
    • B) forearm
  13. The pathophysiologic changes of increased compartment pressure are sometimes referred to as the AAA.
    ischemia-edema cycle
  14. In Aute Compartment Syndrome AAA generally appear before changes in vascular or motor signs.
    sensory deficits or paresthesia
  15. After paresthesia in Acute Compartment Syndrome the AAA, and BBB.
    • A) color of the tissue pales
    • B) pulses begin to weaken but rarely disappear
  16. After paresthesia in Acute Compartment Syndrome the affected area is AAA, and pain occurs with BBB of the extremity.
    • A) usually palpably tense
    • B) passive motion
  17. If Acute Compartment Syndrome is not treated ... occur.
    • cyanosis
    • tingling
    • numbness
    • paresis
    • severe pain
  18. Within AAA after the onset of compartment syndrome, neurovascular and muscle damage are irreversible. The limb can become useless in BBB.
    • A) 4 to 6 hours
    • B) 24 to 48 hours
  19. If ACS (Acute Compartment Syndrome) is verified, the surgeon may perform a AAA, or opening in the fascia, after which the open wound is packed and dressed BBB until secondary closure occurs, usually in CCC depending on the patient's healing ability.
    • A) fasciotomy
    • B) daily or more often
    • C) 4 to 5 days
  20. Volkmann's contractures of the AAA, which can begin within BBB of the pressure increase, result from shortening of the ischemic muscle and from nerve involvement.
    • A) forearm
    • B) 12 hours
  21. Myoglobinuric renal failure, known as AAA, from muscle breakdown is a potentially fatal complication of BBB.
    • A) rhabdomyolysis
    • B) compartment syndrome
  22. ACS (Acute Compartment Syndrome) can begin in AAA after an injury or take up to BBB to appear.
    • A) 6 to 8 hours
    • B) 2 days
  23. Assess for signs and symptoms of hypovolemia, hyperkalemia, and compartment syndrome - these are signs of AAA, which can occlude the distal renal tubules with BBB and result in kidney failure.
    • A) Crush Syndrome
    • B) myoglobin
  24. Adequate IV fluids, diuretics, and low-dose dopamine to increase renal perfusion may be prescribed for AAA. A urine output of BBB is the desired outcome.CCC may reduce serum potassium adequately, but hemodialysis may be required if potassium levels remain high or kidney failure occurs.
    • A) Crush Syndrome
    • B) 100 to 200 mL/hr
    • C) Kayexalate
  25. Fat embolism syndrome (FES) is another serious complication in which fat globules are released from the yellow bone marrow into the bloodstream within AAA after an injury or other illness.
    12 to 48 hours
  26. The earliest manifestation of FES (Fat Embolism Syndrome) is AAA, which is caused by BBB. Assess for CCC.
    • A) altered mental status
    • B) a low arterial oxygen level
    • C) decreased level of consciousness (LOC), such as drowsiness and sleepiness
  27. Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and its major complication, pulmonary embolism (PE). It is the AAA of lower extremity surgery or trauma and the most often BBB of musculoskeletal surgery.
    • A) most common complication
    • B)  fatal complication
  28. Ischemic necrosis is sometimes referred to as AAA or osteonecrosis. Blood supply to the bone is disrupted, leading to the death of bone tissue. This problem is most often a complication of BBB or any fracture in which there is displacement of bone.
    • A) aseptic or avascular necrosis (AVN)
    • B) hip fractures
  29. Delayed union is a fracture that has not healed within AAA of injury.
    6 months
  30. Perform a thorough neurovascular assessment (when bone fracture is suspect), and compare extremities. Assess AAA thru EEE. If the fracture involves an extremity, check the nails for capillary refill by applying pressure to the nail and observing for the speed of blood return. If nails are brittle or thick, assess the skin next to the nail.
    • A) skin color and temperature
    • B) sensation - paperclip to web between thumb and first finger and same with toes
    • C) mobility - active and passive
    • D) pain - out of proportion to injury and unrelieved by analgesics may indicate compartment syndrome.
    • E) pulses distal to the fracture site.

    F) Capilary refill is least reliable. Skin next to nails if brittle or thick. Within 3 seconds or 5  for older pts.
  31. For fractures of the shoulder and upper arm, the physical assessment is best done with the patient ...
    in a sitting or standing position, if possible, so that shoulder drooping or other abnormal positioning can be seen.
  32. Neurovascular assessment is rechecked after ...
  33. Elevate the fractured extremity higher than the heart, and apply ice for the first AAA as needed to reduce edema.
    24 to 48 hours
  34. A traditional plaster-of-Paris cast requires application of a AAA under the material. If the AAA is too tight, it may impair circulation.
    A) wellfitted stockinette
  35. Infection most often results from the breakdown of skin under the cast (AAA?). If this occurs, the patient typically reports a very painful “hot spot” under the cast and the cast may feel warmer in the affected area.
    A) pressure necrosis
  36. 5 Ps of Neurovascular assessment often with fracture
    • Pain
    • Pallor
    • Pulselessness
    • Paresthesia
    • Paraplegia
  37. Reduction is a medical procedure to ...
    restore a fracture or dislocation to the correct alignment
  38. Complications of Fractures
    • Shock
    • Fat embolism syndrome
    • Venous thromboembolism
    • Infection
    • Chronic complications—ischemic necrosis, AVN, delayed bone healing
    • Peripheral neurovascular dysfunction
    • Pain
    • Impaired physical mobility
    • Inadequate nutrition
  39. For traction pts.: Inspect the skin at least every AAA for signs of irritation or inflammation.
    8 hours
  40. Certain complications specific to fractures and musculoskeletal surgery include AAA and BBB.
    • A) fat embolism
    • B) venous thromboembolism
  41. AAA should never be used for older adults because it has toxic metabolites that can cause seizures and other complications. Many hospitals no longer use this drug for patients of any age.
    A) Meperidine
  42. Muscle spasms are best relieved by ...
    application of heat and massage.
  43. If swelling causes pressure on the affected area, AAA of the affected body part may be appropriate.
    ice and elevation
  44. To prevent pressure on the axillary nerve, there should be AAA between the axilla and the top of the crutch when the crutch tip is at least BBB diagonally in front of the foot. The crutch is adjusted so that the elbow is flexed no more than CCC when the palm is on the handle
    • A) two to three finger breadths
    • B) 6 inches (15 cm)
    • C) 30 degrees
  45. The cane is placed on the AAA side and should create no more than BBB of flexion of the elbow. The top of the cane should be parallel to the CCC.
    • A) unaffected
    • B) 30 degrees
    • C) greater trochanter of the femur or stylus of the wrist
  46. For patients who have lower extremity fractures, less weight bearing on long bones can cause ...
  47. Fracture healing nutrition:
    —Diet high in:

    • protein
    • calories
    • calcium
    • supplemental vitamins B and C—
    • foods high in iron
  48. Most vertebral fractures are associated with AAA, BBB and CCC, not acute spinal injiry.
    • A) osteoporosis
    • B) metastatic bone cancer
    • C) multiple myeloma
  49. Nonsurgical management includes AAA, BBB, CCC and DDD. Vertebral compression fractures (VCFs) that remain painful and impair mobility may be surgically treated with EEE and FFF.
    • A) bedrest
    • B) analgesics
    • C) nerve blocks
    • D) hysical therapy to maintain muscle strength
    • E) vertebroplasty
    • F) kyphoplasty.
  50. Kyphoplasty is preferred because it AAA and it may restore height to decrease kyphosis
    reduces the complication of leaking of bone cement outside the vertebral body
  51. PLP (phantom limb pain) is more common in patients who had chronic limb pain before surgery and rare in those who have ...
    traumatic amputations
  52. Routine activities such as AAA can trigger the pain. If pain is long-standing, especially if it existed before the amputation, any stimulus can cause it, including touching any part of the body.
    A) urination
  53. AAA analgesics are not as effectivefor PLP as they are for residual limb pain. IV infusions of BBB during the week after amputation can reduce phantom limb pain.
    • A) Opioid
    • B) calcitonin (Miacalcin, Calcimar)
  54. PLP drugs for constant, dull, burning pain:
    beta-blocking agents such as propranolol (Inderal, Apo-Propranolol, Detensol)
  55. PLP drugs for knifelike or sharp burning pain:
    Antiepilepticdrugs such as carbamazepine (Tegretol) and gabapentin (Neurontin)
  56. PLP drugs for muscle spasms or cramping:
    Antispasmodicssuch as baclofen (Lioresal)
  57. A AAA is essential for preventing contractures with a leg amputation. Assist the patient into a BBB position every CCC for DDD periods if tolerated and not contraindicated.
    • A) firm mattress
    • B) prone
    • C) 3 to 4 hours
    • D) 20- to30-minute
  58. AAA wrapping prevents restriction of blood flow. Decrease the tightness of the bandages while wrapping in a BBB direction.
    • A) Figure-eight
    • B) distal-to-proximal
  59. For wrapping to be effective, reapply the bandages every AAA or more often if they become loose. Figure-eightwrapping prevents restriction of blood flow. Decrease the tightness of the bandages while wrapping in a BBB direction.
    • A) 4 to 6 hours
    • B) distal-to-proximal
  60. When the anterior cruciate ligament (AAA?) is torn, a snap is felt, the knee gives way, swelling occurs, and stiffness and pain follow
  61. If the dislocation is not complete, the joint is partially dislocated, or subluxed. It can occur in any AAA joint but is most common in the BBB thru EEE.
    • A) diarthrodial (synovial)
    • B) shoulder, hip, knee, and fingers
  62. AAA is excessive stretching of a muscle or tendon when it is weak or unstable. A first-degree (mild) strain causes mild inflammation but little bleeding. Swelling, BBB and tenderness are usually present. A second-degree (moderate) strain involves CCC. Muscle function may be impaired. A third-degree (severe) strain involves a DDD. Severe pain and disability result from severe strains.
    • A) strain
    • B) ecchymosis (bruising)
    • C) tearing of the muscle or tendon fibers without complete disruption
    • D) ruptured muscle or tendon with separation of muscle from muscle, tendon from muscle, or tendon from bone
  63. A AAA is excessive stretching of a ligament. A first-degree (mild) sprain involves tearing of a few fibers of a ligament. BBB. In a second-degree (moderate) sprain, more fibers are torn but the CCC. A third-degree (severe) sprain causes DDD of the joint.
    • A) sprain
    • B) Function of the joint is not impaired
    • C) joint remains stable
    • D) marked instability
  64. A 54-year-old man presents to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no openings in the skin. A pulse cannot be obtained by touch to the right foot, which is pale and cool to palpation. The patient rates his pain as an “8” on a 0-to-10 scale. Which is the priority nursing action at this time?

    A. Prepare for reduction.
    B. Obtain a Doppler of the right foot pulse.
    C. Administer pain medication.
    D. Notify the physician of the lack of a pulse in the right foot.
    B. Obtain a Doppler of the right foot pulse.

    Thenurse should obtain a Doppler reading to see if any pulse can be detected at all. Then, subsequent actions could include notifying the physician, administering pain medication, and preparing for reduction.
    (this multiple choice question has been scrambled)
  65. An ankle x-ray confirms that the patient has an ankle fracture. A fiberglass cast is applied to immobilize the ankle and allow for healing. Which are priority interventions after the cast is applied? (Select all that apply.)

    A. Monitor for signs of infection.
    B. Assess peripheral capillary refill.
    C. Keep the cast uncovered for air-drying over several hours.
    D. Ask the patient about frequency of bowel movements.
    E. Insert a finger between the skin and the cast to be sure the cast is not too tight.
    A, B, D and E

    A synthetic cast such as fiberglass will dry within 10 to 15 minutes and can bear weight 30 minutes after application.

    Plaster casts are not used so much and can take 2-3 days to dry.
  66. The patient with the broken ankle tells the nurse that he was jogging to train for a marathon, which has been a lifelong goal. He asks, “Will I ever be able to run a marathon now?” What is the correct nursing response?

    A. “Of course; after this heals, you will be fine.”
    B. “The doctor will be able to tell you that.”
    C. “It is unlikely that your ankle will regain the necessary strength.”
    D. “It sounds like you are concerned that you may not be able to achieve your goal.”
    D. “It sounds like you are concerned that you may not be able to achieve your goal.”

    To whch the patient replies: "Am I freaking mumbling?"
    (this multiple choice question has been scrambled)
  67. The patient’s ankle heals and his cast is removed. Which teaching point would you include for care of his ankle after the cast is removed?

    A. Wear a support stocking to prevent lower extremity swelling.
    B. Keep your ankle in a low position to facilitate perfusion to the healed bone.
    C. Exercise vigorously at least 3 times a day as directed by the physical therapist.
    D. Scrub your lower leg and ankle to remove dead, scaly skin.
    A. Wear a support stocking to prevent lower extremity swelling.

    The ankle should be supported on pillows, not dependent.

    Dead scaly skin should be removed by soaking, not scrubbing.

    Exercise should be done slowly.
    (this multiple choice question has been scrambled)
  68. A possible outcome for a patient who experienced a crush injury of his lower extremity may be:

    A. Hypotension
    B. Peripheral nerve injury
    C. Bradycardia
    D. Rhabdomyolysis
    D. Rhabdomyolysis

    Crush injuries cause several potential complications. The release of myoglobin from the muscle places the patient at high risk for developing rhabdomyolysis and renal dysfunction, which requires immediate intervention. Potassium is also released and may cause cardiac dysrhythmias. If extensive blood volume is lost, the patient is at risk for developing hypovolemia (not hypotension). Presence of peripheral nerve injury should be assessed with all musculoskeletal trauma.
    (this multiple choice question has been scrambled)
  69. A priority question to ask an older female with a long bone fracture would be:

    A. “Do your feet get cold at night?”
    B. “Do you take any over-the-counter medications?”
    C. “How many servings of dairy products do you consume daily?”
    D. “Are you taking estrogen supplements?”
    D. “Are you taking estrogen supplements?”

    Think in terms of moving forward, how did we get here.

    Several dietary factors and chronic illnesses influence the healing of bones in older adults. For women, the loss of estrogen after menopause is detrimental to the body’s ability to form new bone tissue. Thus assessing if the patient takes estrogen supplements is an important health history question. Other questions about the patient’s diet and over-the-counter medications such as herbal supplements or multivitamins are also important. Peripheral vascular disease and/or a history of arteriosclerosis will also negatively influence healing.
    (this multiple choice question has been scrambled)
  70. A middle-aged male patient has a tight cast on his left lower leg. An early assessment variable requiring further evaluation for compartment syndrome would be:

    A. Discoloration of toes
    B. Pain more intense than that of the injury itself
    C. Tingling sensation
    D. Diminished pulses
    B. Pain more intense than that of the injury itself

    The classic sign of acute compartment syndrome is pain, and the pain is more intense than what would be expected from the injury itself. Other symptoms include tingling or burning sensations (paresthesias) in the skin. Decreased pulses and numbness or paralysis are late signs of compartment syndrome.
    (this multiple choice question has been scrambled)
  71. The patient with a history of osteoporosis is at high risk for developing what type of fracture?

    A. Fatigue
    B. Compound
    C. Simple
    D. Compression
    D. Compression

    Compression fracture commonly occurs in the vertebrae of patients with osteoporosis. Fatigue fracture is synonymous with a stress fracture. A compound fracture includes an open wound and may be graded to define the extent of tissue damage. Stress fracture results from excessive stress or strain on the bone.
    (this multiple choice question has been scrambled)
  72. The best diagnostic test to determine musculoskeletal and soft tissue damage is:

    A. Electromyography (EMG)
    B. Computed tomography (CT)
    C. Standard x-rays
    D. Magnetic resonance imaging (MRI)
    D. Magnetic resonance imaging (MRI)

    MRI is useful in determining the amount of soft-tissue damage that may have occurred with the fracture. Standard x-rays and CT are helpful in determining simple and complex bone fractures. EMG assists with diagnosis problems associated with muscles.
    (this multiple choice question has been scrambled)
  73. The nurse is concerned that a client who had an open reduction, internal fixation of his tibia and fibula is at risk for complex regional pain syndrome. What assessment findings at the affected area are common when a client has this complication? Select all that apply.

    A. Dull, aching pain
    B. Decrease in sweating
    C. Muscle spasms
    D. Skin discoloration
    E. Paresis
    F. Edema
    C, D, E and F

    Muscle spasms, skin discoloration, paresis, and edema are all manifestations that present in complex regional pain syndrome.

    The client experiencing this syndrome would have intense, unrelenting, burning pain rather than dull, aching pain, as well as excessive (not decreased) sweating due to dysfunction of the autonomic nervous system.
  74. AAA is the monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases.
  75. While the patient receives moderate sedation, you note that her respiratory rate drops to 8 breaths/min and her capnography reading is 18. What do these values mean? What evidence-based action will you take first as a result of these values? What will you document in the electronic patient record about the patient’s response during the procedure?
    Normal end-tidal CO2 readings are 5% or 35 to 37 mmHg. These values indicated a decreased respiratory rate, hyperventilation, and hypocapnia.

    Hypoventilation ... ???
  76. The nurse plans to refer a client with an amputation and the client's family to which community resource?

    A. National Amputee of America Society (NAAS)
    B. American Amputee Society (AAS)
    C. Community Workers for Amputees (CWA)
    D. Amputee Coalition of America (ACA)
    D. Amputee Coalition of America (ACA)
    (this multiple choice question has been scrambled)
  77. For (traction) pin site care
    Chlorhexidine (Hexicleans), 2 mg/mL solution, is the better cleansing solution
  78. The client has a grade III compound fracture of the right tibia. To prevent infection, which intervention will the nurse implement?
    A. Applying Neosporin (bacitracin, neomycin, and polymyxin B) ointment to the site daily with a sterile cotton-tipped swab
    B. Using strict aseptic technique when cleaning the site
    C. Leaving the site open to the air to keep it dry
    D. Assisting the client to shower daily and pat the wound site dry
    B. Using strict aseptic technique when cleaning the site

    Using aseptic (aka sterile conditions) technique is the best way to prevent infection.
    (this multiple choice question has been scrambled)
  79. The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan?

    A. Avoid rigorous exercise.
    B. Wear helmets when riding a motorcycle.
    C. Avoid contact sports.
    D. Avoid driving in inclement weather.
    B. Wear helmets when riding a motorcycle.

    Those who ride motorcycles or bicycles should wear helmets to prevent head injury.
    (this multiple choice question has been scrambled)
  80. The older adult client has had a right open reduction internal fixation (ORIF) of a fractured hip. Which intervention will the nurse implement for this client?
    A. Keep the client's heels off the bed at all times.
    B. Reposition the client every 3 to 4 hours.
    C. Prohibit the use of antiembolic stockings.
    D. Administer preventive pain medication during deep-breathing exercises.
    A. Keep the client's heels off the bed at all times.

    Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area.

    Repositioning the older adult client must be done every 2 hours to prevent skin breakdown and to inspect the skin for any signs of breakdown.
    (this multiple choice question has been scrambled)
  81. The client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?

    A. "Simple fracture is accompanied by damage to the blood vessels."
    B. "Simple fracture involves a break in the bone, with skin contusions."
    C. "Compound fracture does not extend through the skin."
    D. "Compound fracture, grade I, involves minimal skin damage."
    D. "Compound fracture, grade I, involves minimal skin damage."
    (this multiple choice question has been scrambled)
  82. Compound fracture, grades I - III
    • I - minimal skin damage
    • II - skin and muscle contusions
    • III - damage to skin, muscle, nerve tissues and blood vessels.
  83. Which typical clinical manifestation does the nurse expect to observe for a client with a right tibial fracture?

    A. Mild pain
    B. Flaccid extremity
    C. Crepitation of extremity
    D. No evidence of edema
    C. Crepitation of extremity

    The client with a fracture will typically have a decreased range of motion (ROM) in the affected extremity, but not flaccidity.

    On assessment, crepitation (a continuous grating sound created by bone fragments) may be heard when the affected extremity is moved.
    (this multiple choice question has been scrambled)
  84. The client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction will the nurse plan to include in this client's teaching plan?

    A. Apply Neosporin (bacitracin, neomycin, and polymyxin B) if signs or symptoms of infection develop around pin sites.
    B. Wear the same clothing that is normally worn.
    C. Use pain medication as prescribed to control pain.
    D. Clean the pin site when any drainage is noticed.
    C. Use pain medication as prescribed to control pain.

    Pin sites must be cleaned at least every 8 hours and as needed to reduce the risk for infection.

    If signs and symptoms of infection develop around the pin sites, the client must notify the health care provider immediately. Infection at the pin sites places the client at risk for osteomyelitis.
    (this multiple choice question has been scrambled)
  85. AAA traction is indicated for fracture of the femur or pelvis.
    Balanced skin
  86. AAA may be applied before surgery to help decrease pain associated with muscle spasm assoc with left hip fracture and in considerable pain.
    Buck's traction
  87. AAA traction is indicated for fracture of the humerus with or without involvement of the shoulder and clavicle.
  88. AAA traction is indicated for wrist fracture
  89. A client is admitted to the emergency department after a motorcycle accident with a compound fracture of the left femur. Which action will be most essential for the nurse to take first?

    A. Place a dressing on the affected area.
    B. Administer the prescribed analgesic.
    C. Check the dorsalis pedis pulses.
    D. Immobilize the left leg with a splint.
    C. Check the dorsalis pedis pulses.

    Immobilization will be needed, but the nurse must assess the client's condition first.

    The first action should be to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome (ACS), which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised.
    (this multiple choice question has been scrambled)
  90. Fracture pain is generally described as ...
    sharp, continuous, and increasing in frequency
  91. Bone pain is often described as ...
    a dull, deep ache
  92. Muscle injury is often described as ...
    an aching or cramping pain, or soreness
  93. Strains result from trauma to a muscle body or the attachment of a tendon from overstretching or overextension.
Card Set
NUR 216F 54
Care of Patients with Musculoskeletal Trauma
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