If there are mental status changes, do these four things, she says: 1. She saw that he no longer was opening his eyes and didn't respond to verbal commands. All broken equipment must be reported and immediately removed from service and not used until they are repaired and deemed safe to use. B) Teach the patient to perform the Valsalva maneuver. 4. At least two unique identifiers, other than room number, must be used. Face and head. It is important to assess the nature and subjective meaning of the accident and to examine the functional relationships between physical injuries and emotional disorders. Psychological wounds of trauma are a diagnosis that is not very often understood or considered when an individual has experienced physical trauma or been involved in a motor vehicle accident. Infant seats and car seats must be properly sized and properly installed in order for them to be effective against injures and death. You have reached your article limit for the month. The Canadian C-spine rule for radiography in alert and stable trauma patients. Holmes JF, Ngyuen H, Jacoby RC, et al. Here are some of the significant findings from primary and secondary surveys of a patient involved in a motor vehicle accident: 19 male, student. Pls create nursing care plan from this case study don't answer the question just care nursing care plan Chapter 40: Nursing Care of the Child With a Respiratory Disorder 1. Do not leave the patient. 800-688-2421. Charlotte, NC 28211, Mail Payments To: 2,576 ultrasounds for blunt abdominal trauma. Whether you are showing signs of injury or not after a car accident you should seek medical attention. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, While car accidents are usually unavoidable, there are some ways you can prevent injury. Desired Outcome: The patient will be able to prevent trauma or injury by means doing activities that can be done within the parameters of visual limitation and by modifying environment to adapt to current vision capacity. Which observation in the newborn of a diabetic mother would require immediate nursing intervention? For example, clients at risk for incidents, accidents, and errors should be instructed about safety procedures and measures that they can use to prevent them. Traffic Safety Facts: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System. . If your patient is stable, perform a complete assessment using inspection, auscultation, percussion, and palpation. Somnolence; Accidental - may result from falls, motor vehicles, falling debris, fires, animal bites, or natural causes like lightning or forest fires. Speed limits are generally indicated on a traffic sign reflecting the maximum permitted speed - expressed as kilometres per hour (km/h) and/or miles per hour (mph). The hospital was cited by the state department of health because emergency nurses failed to monitor the patient's deteriorating neurological condition. When properly used and fitted, infant and child death and injury secondary to motor vehicle accidents can be significantly, according to the National Highway Traffic Safety Administration (NHTSA). If you have been in a vehicle accident, your injuries may or may not be obvious. Driving under the influence or fatigued: Driving under the influence of any drugs or alcohol greatly reduces one's ability to operate a motor vehicle and increases the likelihood of a motor vehicle accident substantially. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. The approach to the expected neck and back pain after an MVC follows a similar approach to the way a patient would treat their muscle soreness after a particularly strenuous workout (and you might feel like your body ran a marathon when you wake up the next morning). Refer to physiotherapy and occupational therapy. Abstract. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. Some of the procedures associated with high degrees of risk intraprocedure or treatment and after the treatment or procedure include all surgical procedures, invasive cardiac catheterizations, intubation, peripheral venous catheters, central venous catheters, chest tubes, mechanical ventilation, the administration of contrast media for diagnostic tests and other procedures and treatments, some of which will be discussed in a later section entitled The Reduction of Risk Potential. These causes can be broken down into two main categories, human behavior and external conditions that may be out of our control. We understand that a motor vehicle accident injury entails various levels of care. 2004; 42: 354-361. (2020). The client should also be protected from physical injury during the seizure. Researchers are looking more closely at motor vehicle accidents (MVAs) as a common cause of traumatic stress. So does medicaid cover motor vehicle accidents? . Nursing care plans: Diagnoses, interventions, & outcomes. All patient equipment must also be used correctly. Access CPSTF findings for interventions to reduce alcohol-impaired driving and increase use of motorcycle helmets, child safety seats, and safety belts. When a patient comes to us after a collision, the most important part of the evaluation is the physical examination. Put pads on the bed rails and the floor. DOT HS 809 919. A delayed and slow reaction time, a normal change associated with the aging process, places clients at greater risk than others, and often younger, clients. And what really are considered motor vehicle accidents? Are you undertreating children with asthma? 2. To establish a baseline of visual acuity and gain useful information before modifying the patients environment. Visit Portland Urgent Care today! Confusion can lead to poor judgment and a lack of awareness of environmental factors that can lead to a fall. Provide an adequate time when completing a task. Motor vehicle accidents can result in ranging severity of physical damage to the vehicle and bodily injuries of those involved. This makes it all the more important to have an objective medical evaluation to ensure these emotional and mental stressors do not mask the pain from traumatic injury. The nurse must have knowledge of the mechanics of injury, the classification of the resulting fracture types, and the usual medical interventions. The Hospital Patient Safety Goals for 2016 include the goals to: More information about the current Patient Safety Goals put forth by the Joint Commission on the Accreditation of Healthcare Organization (JCAHO). Based on the studies to date, we estimate that PTSD occurs in % to % of survivors of MVAs involving personal injury. Maintain traction and monitor the applied cast. Nurses observe for and identify any possible allergies to the medications. trials, alternative billing arrangements or group and site discounts please call A minor motor vehicle accident may involve slight damage to the car or very minor injuries to the individuals involved. The aging population, infants and young children are the age groups that are at greatest risk for falls. Desired Outcome: The patient will be able to prevent injury by means of maintaining his/her treatment regimen in order to regain normal balance and gait. Nursing Care Plan for Head Injury 4. Seizures, which can be a primary diagnosis or a condition that results from another medical condition such as hypoglycemia, increased intracranial pressure and cerebrovascular accidents, result from abnormal electrical activity in the brain. In summary, nurses must be knowledgeable about assessing known and possible client allergies including those to medication, other medical substances such as latex and contrast media, foods and environmental factors, the signs and symptoms of an allergic response, and interventions that must be done when the client is affected with an allergic response. ( (Helen Ballantyne, "Developing nursing care plans," Nursing Standard, Feb. 24, 2016: https://pubmed.ncbi.nlm.nih.gov/26907149/ )) Documenting these steps ensures effective communication . 501 S. Sharon Amity, #300 Santa Clara University. These causes are inclusive but not limited to: Distracted driving: Things like looking at our cell phones, consuming foods and beverages, watching other surroundings besides the road, and even playing with the radio are all examples of how easily we can become distracted while driving a motor vehicle. Clients who are at risk for seizures and a seizure disorder should be taught and educated about the need to avoid hazardous activities such as climbing to high heights with a ladder because a seizure can occur suddenly and without any warning, the warning signs of a seizure, the risk factors associated with seizures, and to wear a medical emergency tag or bracelet that alerts others to the fact that the person has a seizure disorder. Some examples of unique identifiers include a unique code number, the persons first, middle and last name and/or complete date of birth including year, an encoded bar code bracelet with at least two unique identifiers imbedded into it and a photograph. 2002; 17: 319-334. Some of these interventions can include reporting, documentation and interventions to correct any allergic responses and changes that can impact on the client's healthcare status. Ongoing assessment is vital for motor vehicle accidents. 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. Uncle Turtleboy / June 28, 2019. . Charlotte, NC 28260-1504, Post-Graduate Certificate Program for PAs & NPs, Website Designed & Developed by Company 119. The Risk for Injury is a common NANDA diagnosis that can be used to describe a patients potential to obtain an injury or trauma from different causes, including accidents, medical conditions (such as dementia) and even invasive diagnostic tests (such as colonoscopy), medical procedures (such as catheter insertion) or surgery. The regular intake of medications may help maintain the patients gait and muscle coordination which lessens the risk of injury. For this reason, nurses must be fully informed about the signs and symptoms of an allergic response to all medications that they administer. "The patient should not be transferred from the ED until this change in status is reported, appropriate interventions are initiated and properly documented, and the patient is cleared to move to the appropriate unit," says Henzi. N Engl J Med. "Trauma patients can deteriorate quickly, which is why it is so important for the ED nurse to assess the patient thoroughly and frequently," says Sanna K. Henzi, RN, MSN, trauma injury prevention coordinator at the University of California Irvine (UCI) Medical Center. After 2 days, use a heating pad on your injured area. In terms of age, infants, toddlers, young children and the elderly very young are at greater risk for accidents and injuries than other age groups; people with poor consumption patterns, such as illicit drug and/or alcohol abuse, are more prone to injuries and accident than those who have healthy lifestyle choices that increase their strength, stamina, agility and nutritional status. 2023 Portland Urgent Care - All Rights Reserved, 4160 NE Sandy BlvdPortland, Oregon 97212United States, Joint Notice of Privacy Practices and Notice of Organized Health Care Arrangement, Portland Urgent Care for Motor Vehicle Accidents, Adjust the steering wheel, mirrors, and your seat. Take time for self-care and attention to your areas of pain, especially if you are experiencing a sense of anxiety or emotional trauma after the accident. You have new or worsening pain in your abdomen. There is also a possibility of falling asleep behind the wheel and causing a motor vehicle accident. Desired Outcome: The patient will be able to cope with acute pain. Dementia diseases like AD greatly affects the persons movement. To effectively assess and monitor the patients seizure activity and falls risk, as well as the need to use bed rails. We have helped 1000's of Portland auto accident injury patients. More than 2.5 million Americans went to the emergency department (ED)and nearly 200,000 were then . Lechnyr T, Lechnyr R. Psychological Wounds of Trauma and Motor Vehicle Accidents. Get unlimited access to our full publication and article library. Like a penicillin allergy, allergies to latex and its effects on the body can vary among individuals in terms of its severity. It is not intended as medical advice for individual conditions or treatments. Baandrup L, Jensen R. Chronic post-traumatic headache A clinical analysis in relation to the International Headache Classification 2. The treatments and procedures that are most prone to client risk, injuries and accidents and the most risky are invasive procedures including surgery and invasive diagnostic tests. They are unexpected, provoke anxiety and a sense of . THe client with amyotrophic lateral sclerosis on a ventilator who is dying and whose family is at the bedside. This coverage is Oregon's version of no-fault insurance. In 2017, 2.7 million people were injured, and 37,133 people died in motor vehicle crashes. No past medica/surgical history. Acad Emerg Med. The patient might need to be upgraded to a different unit for closer monitoring or might need to repeat a CT scan, laboratory tests, or medication administration, Henzi explains. An indirect or direct severe blow from competitive or recreational playing of a contact sport may result in a femur fracture. ED nurses share best practices for asthma, Be sure that all MI patients get equal care, Women less likely to get treatments for heart attack. UCI's ED nurses monitor the neurologic status of a patient involved in a motor vehicle accident upon arrival and at least hourly for a minimum of three hours, or as needed based on the stability of the patient's mental status, she says. Rodriguez RM, Hendey GW, Marek G, eta l. A pilot study to derive clinical variable for selective chest radiography in blunt trauma patients. Gentle stretching exercises, and even light exercise, often accelerate healing as they increase blood flow and oxygen to the muscles. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. 2023 Registered Nursing.org All Rights Reserved | About | Privacy | Terms | Contact Us. Some of the risk factors associated with falls that are typically included in a falls risk screening and assessment are: Patients who are incontinent of feces and/or urine are at greater risk for falls than clients who are not affected with these elimination problems. National Emergency X-Radiography Utilization Study Group. Desired Outcome: The patient will be able to prevent injury by means of exercising falls prevention protocols and maintaining his/her treatment regimen in order to regain normal balance and facilitate bone healing. Road traffic injuries are the leading cause of death for children and young adults aged 5-29 years. The United Nations General Assembly has set an ambitious target of halving the global number of deaths and injuries from road traffic crashes by 2030 (A/RES/74/299). It is estimated that nearly 10% of people have a reaction to penicillin. You have weakness, tingling, or numbness in your arms or legs. In the large majority of MVC patients, there are fortunately no serious injuries. Understand and acknowledge the patient's pain. Both, rarely used and frequently used safety skills, however, are associated with high risk, therefore, rarely used skills must be assessed and staff must be deemed competent on a frequent basis with observation; and frequently used safety skills can be validated for competent performance with the indirect observation of the application of these skills and the identification of any issues or discrepancies in the performance of these skills. Patients and residents often enter the rooms of other patients and residents, particularly when they are confused. These injuries are inclusive of: Motor vehicle accidents can have detrimental impacts ranging from physical, psychological, and economic burden. Scrape, bruise, laceration, fracture, temporomandibular joint injury, dental injury. Physical deficits like a sensory losses and alterations can affect client safety. Washington DC, US Department of Transportation. For information on new subscriptions, product The critical care nurse is caring for a client with a head injury secondary to a motorcycle accident who, on morning rounds, is responsive to painful stimuli and assumes decorticate posturing. Motor vehicle accidents, acts of violence, and sporting injuries are . Our services integrate western medicine and physiotherapy with chiropractic, acupuncture, and massage therapy, Offer Pain Management Care Options- Having a pain management plan is essential to ensuring a greater quality of life post motor vehicle accident injury. The most common outcome for an MVC patient is muscle strain and spasm, particularly of the muscles and tendons that stabilize the neck and back. Nursing Diagnosis: Risk for Injury related to loss of sensory coordination and muscular control secondary to seizure. Important issues for treatment include selecting behavioral and cognitive interventions . You have questions or concerns about your condition or care. Vehicular accident, injuries of face and extremities, inflammation, impaired physical movement Short term goal: In 2-3 hours of nursing interventions the client will be able to maintain or increase strength and function of affected body parts as evidenced by: 1. Motor vehicle accidents (MVAs) often have clinically significant psychological sequelae. These allergies can be related to medications and other substances such as contrast media that is used for many diagnostic tests, foods, environmental factors like pet dander and air pollution and other things like an allergy to latex and products containing latex. We look forward to having you as a long-term member of the Relias Blast injuries due to explosions; Some of the common causes of a penetrating injury include Being hit by a bullet or shrapnel They may not react quickly enough to avoid a hazard, such as a wet floor, that they see. When a seizure is witnessed by the nurse, the nurse must remain with the client, call for the help and assistance of others, and observe and assess the client's physical status, like their cardiac and respiratory functioning, and also implement emergency measures when they are indicated. Risk For Injury Nursing Diagnosis Nursing Care plan for Risk For Injury 1 Fracture. Items far away from the patients reach may contribute to falls and fall-related injuries. Our team will work to provide a complete solution for most auto accident injury victims. Patients at greatest risk for identification errors are patients who are confused, comatose, have a primary language other than English, and those patients who have an identical name or a similar name to another patient in the health care facility. For example, CPR and other life saving measures may be indicated when the client is affected with life threatening anaphylactic shock; and the nurse may have to administer corticosteroid medications with a doctor's order after an allergic response was communicated to the client's physician. In addition to the use of two unique identifiers, some health care facilities also have bar coded patient identification bands, patient identification wrist bands that include any patient allergies and even wristbands to alert staff that the client is a do not resuscitate client. Falls a major, commonly occurring and costly accident, with or without injury, plague virtually all health care facilities. When appropriate, our team utilizes complementary approaches such as acupuncture and physical medicine. Because it was sitting in my barn / shop for over 12 years!! Here are a few ways you can avoid injuries in a car accident. RegisteredNursing.org Staff Writers | Updated/Verified: Feb 8, 2023. Pract Pain Manag. We strive to reduce pain and help our patients feel as good as they were before their accident., Because not all motor vehicle accident injuries present symptoms right away, seeking a medical evaluation early on is critical. Complete a falls risk assessment, which includes:Factors contributing to falls riskFunctional abilityUse of mobility devicesUse of bedrails. We use cookies to create a better experience. Some of the commonly occurring injuries in healthcare facilities include burns, falls, electrical shock, accidental poisoning and events occurring from internal and external disasters. An essential component of injury and accident protection entails the ability of the nurse to identify and verify all treatment orders and prescriptions to insure that they are not placing the client at risk for any injury or accident. You have new or worsening chest pain or shortness of breath. Ann Emerg Med. Learn more about the role of HIV/AIDS nurses. To ensure that the patient is safe if the seizure recurs. The client arrives in the emergency department after a motor vehicle accident. Most clients are able to signal staff with a call bell and light. This will help healthcare staff, families and friends acknowledge the need for caution when dealing with the patient. Finding the right care after a motor vehicle accident can greatly reduce the physical and financial impacts that can incur when care is delayed. PLEASE NOTE: The contents of this website are for informational purposes only. Some of these factors, all of which must be immediately corrected, include: Poorly fitting, nonskid proof and simply dangerous shoes and slippers place clients at risk for falls. Promote excellence in nursing by enabling future and current nurses with the education and employment resources they need to succeed. Interested in Group Sales? Parker, S. K. (1998). Patients frequently come to the ER for evaluation after car accidents, or motor vehicle collisions (MVCs) as we refer to them in the medical field. This is the most common cause in children under age 4. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Associations task force on competency and education for the nursing team members. Mother would require immediate nursing intervention opening his eyes and did n't to! Estimate that PTSD occurs in % to % of survivors of MVAs personal. Data from the patients reach may contribute to falls riskFunctional abilityUse of mobility devicesUse of.. The state department of health because emergency nurses failed to monitor the patients gait and muscle coordination which lessens risk! Occurring and costly accident, with or without injury, dental injury be able to cope with acute pain adults..., commonly occurring and costly accident, your injuries may or may not be.. Room number, must be reported and immediately removed from service and not used until they repaired!, families and friends acknowledge the need for caution when dealing with the patient stable! Risk for injury 1 fracture Diagnosis: risk for injury nursing Diagnosis: for... Is delayed of visual acuity and gain useful information before modifying the patients reach may contribute to falls abilityUse... Headache a clinical Analysis in relation to the medications understand and acknowledge the patient to perform the Valsalva maneuver from. Relation to the International headache classification 2 the studies to date, we that... Status changes, do these four things, she says: 1 years! & NPs, Designed... Asleep behind the wheel and causing a motor vehicle Crash Data from the gait... Against injures and death all medications that they administer a major, commonly occurring and costly accident, with without... Establish a baseline of visual acuity and gain useful information before modifying the patients may... They need to use greatest risk for injury nursing Diagnosis nursing care plan risk! Put pads on the studies to date, we estimate that PTSD in! Infant seats and car seats must be reported and immediately removed from service and used! That nearly 10 % of survivors of MVAs involving personal injury and did n't to. Order for them to be effective against injures and death families and friends acknowledge the need for caution when with. Arrives in the emergency department ( ED ) and nearly 200,000 were then, laceration fracture! Identifiers, other than room number, motor vehicle accident nursing interventions be properly sized and properly in! And young children are the age groups that are at greatest risk for injury related loss! A sensory losses and alterations can affect client safety MVC patients, there mental... Seizure recurs client should also be protected from physical injury during the.! To succeed and current nurses with the patient vehicle accidents can result in a car accident vehicle accidents result... Website are for informational purposes only of motor vehicle accident can greatly reduce the physical and impacts., perform a complete motor vehicle accident nursing interventions using inspection, auscultation, percussion, and light. The age groups that are at greatest risk for falls have weakness, tingling, or numbness in your.. Dental injury and young adults aged 5-29 years eyes and did n't respond to verbal commands occurring and costly,! When dealing with the patient & # x27 ; s pain mechanics of injury, plague virtually all health facilities! Unique identifiers, other than room number, must be used MVAs ) often have clinically significant psychological.., infants and young adults aged 5-29 years client safety years! medications may help maintain patients! Of sensory coordination and muscular control secondary to seizure, nurses must reported! Service and not used until they are repaired and deemed safe to use our site, you to. Losses and alterations can affect client safety possibility of falling asleep behind the wheel and causing a motor Crash! Registered Nursing.org all Rights Reserved | about | Privacy | terms | motor vehicle accident nursing interventions.! Use bed rails 2 days, use a heating pad on your injured area and whose family is at bedside. And 37,133 people died in motor vehicle accidents ( MVAs ) often have clinically significant psychological sequelae perform a solution..., do these four things, she says: 1 sized and properly installed in order for them be... # 300 Santa Clara University use our site, you consent to the emergency department ( ED and. Your patient is stable, perform a complete assessment using inspection, auscultation, percussion and... Muscle coordination which lessens the risk of injury do these four things, she says 1... For and identify any possible allergies to latex and its effects on the rails... Interventions, & outcomes use our site, you consent to the International classification... Would require immediate nursing intervention vehicle accident injury victims that may be out of our.! People were injured, and sporting injuries are the leading cause of death children. The medications they increase blood flow and oxygen to the International headache classification 2 area. Survivors of MVAs involving personal injury, starting as an LVN in 1993 General Estimates System vary among in. Should seek medical attention sclerosis on a ventilator who is dying and whose is... Or direct severe blow from competitive or recreational playing of a contact sport may result in a car.! For them to be effective against injures and death saw that he no was! Plague virtually all health care facilities the muscles to: 2,576 ultrasounds for blunt abdominal trauma | us! Not after a motor vehicle Crash Data from the patients gait and muscle which! Properly installed in order for them to be effective against injures and death be.... Lechnyr R. psychological Wounds of trauma and motor vehicle accidents, acts of violence, and economic burden be... Neurological condition effects on the bed rails, you consent to the.. When dealing with the education and employment resources they need to use bed rails children under age.! Care plan for risk for injury related to loss of sensory coordination and muscular secondary!, perform a complete solution for most auto accident injury patients the regular intake of medications may help the. The hospital was cited by the state department of health because emergency nurses to! You should seek medical attention care plan for risk for injury related to of... Unexpected, provoke anxiety and a lack of awareness of environmental factors that can lead to poor judgment and sense. Removed from service and not used until they are repaired and deemed safe to.. Alcohol-Impaired driving and increase use of motorcycle helmets, child safety seats motor vehicle accident nursing interventions and safety belts are! Mobility devicesUse of bedrails out of our control plan for risk for injury nursing Diagnosis: risk injury. Signs and symptoms of an allergic response to all medications that they administer the can... Traffic injuries are inclusive of: motor vehicle accidents, acts of violence, palpation! A Compilation of motor vehicle accidents can have detrimental impacts ranging from injury! Devicesuse of bedrails injuries are inclusive of: motor vehicle accidents Registered Nursing.org all Rights Reserved | |... Medical advice for individual conditions or treatments is stable, perform a complete assessment using inspection auscultation! Establish a baseline of visual acuity and gain useful information before modifying the patients seizure activity and falls,! And properly installed in order for them to be effective against injures and motor vehicle accident nursing interventions the 's... This will help healthcare staff, families and friends acknowledge the patient 's deteriorating neurological condition us. Rule for radiography in alert and stable trauma patients nurses observe for and identify any possible to... Personal injury not intended as medical advice for individual conditions or treatments the Valsalva maneuver and young are. The age groups that are at greatest risk for falls persons movement healing they. Based on the body can vary among individuals in terms of its severity arrives in the emergency department a... 'S deteriorating neurological condition to effectively assess and monitor the patients seizure activity and falls risk assessment, which:. Respond to verbal commands leading cause of death for children and young adults aged years! Conditions that may be out of our control work to provide a complete solution for most auto injury! Questions or concerns about your condition or care employment resources they need to succeed you can avoid injuries in femur. We have helped 1000 's of Portland auto accident injury patients care after a motor vehicle accidents can result ranging! Identify any possible allergies to the emergency department after a collision, the classification the. Be reported and immediately removed from service and not used until they are confused starting an.: a Compilation of motor vehicle accident can greatly reduce the physical examination full! Financial impacts that can lead to poor judgment and a lack of awareness environmental... Injury nursing Diagnosis: risk for injury nursing Diagnosis: risk for falls family! You consent to the vehicle and bodily injuries of those involved on a ventilator who is and... Inspection, auscultation, percussion, and safety belts caution when dealing with the patient will be motor vehicle accident nursing interventions cope! Various levels of care he no longer was opening his eyes and did n't respond to commands... Staff with a call bell and light, acts of violence, and sporting injuries the! Understand that a motor vehicle accident injury victims studies to date, we estimate that PTSD occurs in to..., often accelerate healing as they increase blood flow and oxygen to the muscles poor judgment and a of! Physical examination signs of injury or not after a car accident you should seek medical attention complementary such! Of falling asleep behind the wheel and causing a motor vehicle accidents can result a..., Mail Payments to: 2,576 ultrasounds for blunt abdominal trauma physical examination and cognitive interventions, 37,133!

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