Additional requirement for verbal/electronic prescriptions with dispensing directive for Medicaid patients

Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction, leading to muscle weakness and fatigue.

Neostigmine is a medication that is commonly used to treat MG by increasing the levels of acetylcholine, a neurotransmitter that is important for muscle contraction. Doubling the dose of neostigmine in a patient with MG can sometimes lead to a paradoxical increase in weakness, which is known as a cholinergic crisis. This can occur due to an excess of acetylcholine, which overstimulates the muscles and can cause them to become weaker.

Symptoms of a cholinergic crisis can include increased muscle weakness, difficulty breathing, excessive salivation, nausea, vomiting, diarrhea, sweating, and low blood pressure. In severe cases, a cholinergic crisis can be life-threatening and require hospitalization.

If a patient with MG experiences an increase in weakness after doubling the dose of neostigmine, it is important to seek medical attention immediately. The dose of neostigmine may need to be adjusted or other treatments may need to be considered to manage the symptoms of MG.

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The correct answer to the given question is 260 mL/h.

The fluid resuscitation rate for a burn patient is calculated using the Parkland formula, which is based on the patient's weight, the extent of the burn, and the time since the burn occurred. The formula is as follows:

Total Fluid Volume = 4 mL × Body Weight (in kg) × % Total Body Surface Area (TBSA) Burned

For this patient, we know that the TBSA burned is approximately 35% based on the areas affected. To convert the patient's weight from pounds to kilograms, we divide by 2.2:

125 lbs ÷ 2.2 = 56.8 kg

Plugging in the values, we get:

Total Fluid Volume = 4 mL × 56.8 kg × 35% = 8019.2 mL or 8.0192 L

Since half of the total fluid volume is given in the first 8 hours, the remaining fluid volume for the next 16 hours would be:

Remaining Fluid Volume = 0.5 × Total Fluid Volume = 0.5 × 8.0192 L = 4.0096 L or 4009.6 mL

To determine the pump rate for the next 16 hours, we need to divide the remaining fluid volume by 16:

Pump Rate = Remaining Fluid Volume ÷ 16 hours = 4009.6 mL ÷ 16 h = 250.6 mL/h

Rounding up to the nearest 10 mL, the pump should be set to 260 mL/h for the next 16 hours. Therefore, the answer is not given in the options provided.

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The nurse should educate the client on the importance of continuing medication to prevent a flare-up and worsening of symptoms.

The nurse should explain to the client that even though they are currently in remission without any symptoms, discontinuing medication can lead to a flare-up and worsening of the disease. The nurse can provide examples of what can trigger a flare-up, such as stress, illness, or injury.

The nurse should also emphasize the importance of following the prescribed medication regimen to prevent joint damage and maintain quality of life. It is important for the nurse to assess any concerns or reasons the client may have for wanting to stop medication and address them accordingly.

The nurse can also collaborate with the healthcare team to explore any potential medication adjustments or alternatives to better manage the client's symptoms. Overall, the nurse should provide education and support to the client to ensure they understand the importance of continuing medication for the management of their rheumatoid arthritis.

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The main difference in excitation-contraction coupling between skeletal and cardiac muscle lies in the way calcium is released and regulated within the muscle fibers.

In skeletal muscle, excitation-contraction coupling occurs when an action potential reaches the neuromuscular junction, causing the release of acetylcholine, which triggers an action potential in the muscle fiber. This, in turn, leads to the release of calcium ions from the sarcoplasmic reticulum, allowing for muscle contraction.In cardiac muscle, the action potential originates in the sinoatrial node and spreads throughout the heart, causing calcium ions to enter the cell through calcium channels. The entry of calcium ions triggers the release of additional calcium ions from the sarcoplasmic reticulum, leading to muscle contraction. Additionally, cardiac muscle has a longer refractory period than skeletal muscle, which allows for proper filling of the heart chambers and prevents tetanic contractions that could impair cardiac function.

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The successful therapy outcome that a nurse would expect in a client diagnosed with invasive cancer of the bladder who has brachytherapy scheduled would be the reduction of the size of the tumor or complete eradication of cancer cells in the bladder.

Brachytherapy involves the placement of radioactive seeds or sources within or near the tumor to deliver a high dose of radiation to the cancer cells while sparing the surrounding healthy tissues. This procedure is aimed at destroying or shrinking the cancerous cells, thereby preventing further spread of the cancer to other parts of the body. Therefore, the nurse would expect that the client's cancer would be successfully treated with minimal side effects, enabling them to resume their daily activities.

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The most common causes of mass lesions in HIV-positive individuals include infections and neoplastic processes.

Infectious causes may include toxoplasmosis, cryptococcosis, tuberculosis, and primary CNS lymphoma. These infections can cause mass lesions in the brain, which can result in symptoms such as headache, confusion, and seizures.

Neoplastic processes that can cause mass lesions in HIV-positive individuals include primary CNS lymphoma, which is a non-Hodgkin lymphoma that arises in the brain, and Kaposi sarcoma, which is a vascular tumor that can affect the skin, mucous membranes, and other organs.

Management of mass lesions in HIV-positive individuals depends on the underlying cause and may involve antimicrobial therapy, corticosteroids, radiation therapy, or chemotherapy.

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As we age, our eyes undergo changes that can affect our vision. Presbyopia, which is a natural aging process in which the lens of the eye becomes less flexible, is a common cause of difficulty seeing nearby objects in older adults. Option (A)

This occurs because the eye's ability to focus on nearby objects decreases with age. Additionally, glaucoma can cause loss of peripheral vision, making it difficult to see nearby objects.

Other conditions such as osteoporosis, migraines, and rheumatoid arthritis do not typically affect vision and are not associated with difficulty seeing nearby objects. A comprehensive eye exam and evaluation by an ophthalmologist can help determine the underlying cause of vision changes in older adults.

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Full Question : Which of the following conditions may cause an older adult to be unable to see nearby objects?

A. Presbyopia

B. Osteoporosis

C. Migraines

D. Rheumatoid arthritis

E. Glaucoma

Some examples of capsular antigen polysaccharide vaccines include the pneumococcal vaccine, the meningococcal vaccine, and the Haemophilus influenzae type b (Hib) vaccine.

Capsular antigen polysaccharide vaccines are vaccines that target the polysaccharide outer layer of certain bacteria that causes infections. The vaccines consist of the purified polysaccharide from the bacterial capsule, which induces the production of antibodies in the body. These antibodies can help prevent infections by binding to the polysaccharide on the bacterial surface, preventing it from invading host cells. Some examples of capsular antigen polysaccharide vaccines include those for pneumococcal bacteria, meningococcal bacteria, and Haemophilus influenzae type B. These vaccines are particularly effective against bacterial infections in vulnerable populations, such as infants, elderly individuals, and those with compromised immune systems. They have been successful in reducing the incidence of bacterial infections and their associated complications.

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Suspected Ventilator Associated Pneumonia (VAP) is a common complication in critically ill patients on mechanical ventilation.

The evaluation should begin with a thorough physical exam, including chest auscultation, to assess for signs of infection such as fever, leukocytosis, and hypoxia. A chest x-ray should be obtained to evaluate for new or worsening infiltrates.

Sputum or blood cultures should be obtained to identify the causative organism. If VAP is suspected, empirical antibiotic therapy should be initiated promptly to cover the most likely pathogens. Antibiotic therapy should be tailored based on culture results and patient-specific factors such as comorbidities, immune status, and antibiotic allergies.

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To provide culturally competent care, a medical assistant should first recognize and acknowledge their own cultural biases and assumptions.

They should then actively listen and communicate with patients to understand their beliefs, values, and practices. This includes asking open-ended questions, avoiding stereotypes, and showing respect for different cultural backgrounds.

The medical assistant should also familiarize themselves with the patient's culture and seek out resources to learn more about it. Additionally, they should be willing to make appropriate accommodations and adjustments to their care to meet the patient's cultural needs and preferences.

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The activity with the health risk most likely to be overestimated by the general public in the United States is flying.

Many people believe that flying is a high-risk activity due to media coverage of rare airplane crashes. However, the risk of dying in a plane crash is extremely low compared to other everyday activities, such as driving a car.

According to the National Safety Council, the lifetime odds of dying in a motor vehicle crash are 1 in 102, while the odds of dying in a plane crash are 1 in 205,552. In addition, flying is subject to rigorous safety regulations and procedures that make it one of the safest modes of transportation.

It is important for the general public to have accurate information about the risks associated with different activities to make informed decisions. While flying may seem scary to some people, it is a very safe travel method.

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The priority nursing intervention during the first 24 hours for a newborn admitted to the neonatal intensive care unit with a myelomeningocele is to prevent infection and protect the exposed spinal cord.

Myelomeningocele is a type of neural tube defect where the spinal cord and surrounding membranes protrude through an opening in the spine. This leaves the spinal cord exposed and puts the newborn at risk for infection. Therefore, the priority nursing intervention during the first 24 hours is to prevent infection by covering the myelomeningocele with a sterile, non-adherent dressing and applying a topical antimicrobial agent. Additionally, the newborn should be placed in a prone position to avoid pressure on the spinal cord.

In summary, preventing infection and protecting the exposed spinal cord is the priority nursing intervention during the first 24 hours for a newborn with myelomeningocele. By implementing these interventions, the newborn can be protected from infection and further complications.

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Of the four options presented, the intake of spicy food is the only nutritional factor that does not influence whether or not a baby will be born malformed.

Malformations are structural abnormalities that can affect various organs or body parts, and they can be caused by genetic, environmental, or nutritional factors. Adequate intake of proteins, vitamins, and minerals is essential for proper fetal growth and development, and their deficiency can increase the risk of birth defects.

For example, lack of folic acid during pregnancy has been associated with neural tube defects, while insufficient iron intake can lead to anemia and impaired oxygen delivery to the fetus. Caloric intake is also important, as both over- and under-nutrition can have adverse effects on fetal development. However, the consumption of spicy food does not have a direct impact on fetal growth or malformations, although it may cause discomfort or heartburn in some pregnant women. Therefore, the correct answer to the multiple-choice question is spicy food intake.

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Yes, acute kidney injury (AKI) or prerenal azotemia can cause acid-base disturbances in the blood, specifically metabolic acidosis.

This is because the kidneys play a key role in maintaining acid-base balance in the body by excreting acid or bicarbonate in the urine. In AKI or prerenal azotemia, the kidneys are unable to adequately remove acid from the blood, leading to an accumulation of acids and a decrease in bicarbonate levels.

This can result in low pH and low bicarbonate levels on arterial blood gas (ABG) analysis. Treatment of the underlying cause of AKI or prerenal azotemia can help correct the acid-base disturbance.

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The most appropriate choice for treating this patient's Aspergillus fumigatus pneumonia is Voriconazole (A).

This antifungal medication is the preferred treatment for invasive aspergillosis, which is a potentially life-threatening infection that commonly affects immunocompromised patients, such as those undergoing chemotherapy. Fluconazole (B) is effective against Candida infections but is not effective against Aspergillus fumigatus.

Flucytosine (C) is used in combination with other antifungal medications to treat certain fungal infections but is not effective against Aspergillus fumigatus. Ketoconazole (D) is not commonly used for invasive fungal infections due to its potential for severe side effects and drug interactions.

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If a 56 year old woman is diagnosed with mild diverticulitis, in addition to counseling her about increased fluid intake and adequate rest, antimicrobial treatment is recommended.

Antimicrobial treatment is commonly prescribed for patients with mild diverticulitis to reduce inflammation and prevent potential complications. The specific antimicrobial medication prescribed may vary depending on the patient's medical history, allergies, and other factors.

It is important for the patient to follow the medication regimen as prescribed by their healthcare provider, and to continue following any other recommendations for managing their diverticulitis, such as a low-fiber diet during the acute phase of the illness. Regular follow-up appointments with the healthcare provider may also be recommended to monitor the patient's progress and adjust treatment as needed.

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Pituitary tumors are abnormal growths that develop in the pituitary gland, a small pea-sized gland located at the base of the brain. These tumors can affect hormone production and cause various symptoms, depending on their size and location. Pituitary tumors can put patients at risk for several health problems, including anorexia and infertility.

Anorexia is a condition characterized by a loss of appetite or a decreased desire to eat, which can lead to severe weight loss and malnutrition.

Pituitary tumors that affect the production of growth hormone or thyroid-stimulating hormone can cause anorexia. Growth hormone deficiency can also lead to decreased muscle mass and bone density, as well as fatigue and weakness.

Infertility is another potential risk associated with pituitary tumors. The pituitary gland produces several hormones that regulate reproductive function, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

These hormones are responsible for stimulating the production of estrogen and testosterone, which are essential for normal reproductive function. Pituitary tumors that affect the production of LH and FSH can cause infertility in both men and women.

In summary, pituitary tumors can put patients at risk for anorexia and infertility, among other health problems, by affecting the production of hormones that regulate various bodily functions.

It's important to seek medical attention if you experience any symptoms of a pituitary tumor, such as headaches, vision problems, or hormonal imbalances. Treatment options may include surgery, radiation therapy, or medication to manage hormone levels.

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The main answer to the question of Stage 4 lung cancer life expectancy without treatment is that it is generally quite low. On average, patients may survive for about 2-4 months without any form of treatment.

The explanation for this is that Stage 4 lung cancer is the most advanced stage of the disease, and it typically indicates that cancer has spread to other parts of the body.

Without treatment, the cancer continues to grow and damage essential organs, leading to severe health complications and eventually death.

In summary, Stage 4 lung cancer life expectancy without treatment is generally short, as the disease is advanced and aggressive at this stage. It's essential for patients to seek appropriate medical care and discuss treatment options with their healthcare team to improve their prognosis.

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The nurse should anticipate the assessment finding of bilateral dilated pupils in a client with a lesion of the sympathetic nervous system.

To explain in detail, the sympathetic nervous system controls the dilation of the pupils, so a lesion in this system can lead to abnormal pupil responses. Bilateral dilation of the pupils indicates that both eyes are affected and is a sign of sympathetic nervous system dysfunction. Nystagmus and Argyll-Robertson pupils are not typically associated with lesions in the sympathetic nervous system.

To explain, a lesion in the sympathetic nervous system can result in a condition known as Horner's syndrome, which affects the pupil's response to light and accommodation. An Argyll-Robertson pupil is a common finding in this condition, characterized by a small, irregularly shaped pupil that constricts poorly in response to light but reacts normally to accommodation.

In summary, the nurse should expect to see an Argyll-Robertson pupil when assessing the eyes of a client with a sympathetic nervous system lesion.

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True. Chronic conditions are a major cause of disability and pain among older adults. Many of these conditions, such as heart disease, stroke, diabetes, and cancer, are preventable or treatable with early detection and intervention.

However, older adults may have multiple chronic conditions, which can complicate their care and increase the risk of disability, hospitalization, and mortality. Pain is also a common symptom associated with chronic conditions and can significantly impact an older adult's quality of life. Effective pain management is essential for improving outcomes and reducing the overall burden of chronic conditions among older adults.

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Absorption of fat via chylomicrons primarily occurs in the small intestine. Specifically, it takes place in the enterocytes, which are specialized cells lining the small intestine's inner surface.

After the ingestion of dietary fats, they are broken down into smaller molecules called fatty acids and glycerol.In the small intestine, the process of fat absorption begins with the emulsification of dietary fats by bile salts, which are produced by the liver and stored in the gallbladder. Emulsification increases the surface area of fat droplets, allowing enzymes called lipases to break down the fats into fatty acids and glycerol.The enterocytes in the small intestine then take up the fatty acids and glycerol and reassemble them into triglycerides. These newly formed triglycerides combine with other molecules, such as cholesterol and proteins, to form chylomicrons. Chylomicrons are large lipoprotein particles that transport dietary fats through the lymphatic system and eventually into the bloodstream.
Once in the bloodstream, chylomicrons deliver the absorbed fats to various tissues throughout the body, where they are either utilized for energy or stored for future use.In summary, the absorption of fat via chylomicrons occurs in the enterocytes of the small intestine, where dietary fats are broken down, reassembled into triglycerides, and packaged into chylomicrons for transport to the bloodstream.

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The correct statement by the patient that indicates understanding of the teaching is option B, "I will soon know that the drugs are effective by being seizure free for several months." This statement shows that the patient understands the goal of antiepileptic drug therapy, which is to control seizures and prevent their recurrence.

AEDs are often prescribed as the first line of treatment for partial complex seizures, and it can take several weeks to months to find the right medication and dosage to control seizures. It is also important to monitor the patient's medication levels and adjust them as needed to maintain therapeutic levels.

Additionally, while serious side effects can occur with AED therapy, patients should never stop taking the medication without consulting with their healthcare provider first. Overall, the patient's statement in option B demonstrates their understanding of the importance of AED therapy in managing their partial complex seizures.

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According to the World Health Organization (WHO), heavy episodic drinking is defined as the consumption of a minimum of six alcoholic drinks in one sitting at least once a month. This pattern of drinking is also known as binge drinking, where an individual consumes a large amount of alcohol in a short period of time.

Heavy episodic drinking can have numerous negative health consequences, including an increased risk of injury, alcohol poisoning, and long-term health problems such as liver disease, cancer, and mental health disorders. The WHO has identified this type of drinking behavior as a major public health concern, and recommends implementing policies to reduce harmful alcohol consumption.

It's important to note that alcohol consumption in general can also have negative effects on health, and the WHO recommends limiting consumption to no more than two standard drinks per day for both men and women. It's crucial to make informed decisions about drinking and to prioritize one's health and well-being.

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Several diseases can cause an increase in both prothrombin time (PT) and partial thromboplastin time (PTT), which are commonly used tests to evaluate the coagulation system.

Liver disease: Liver dysfunction affects the production of clotting factors, leading to increased PT and PTT.

Vitamin K deficiency: Vitamin K is essential for the synthesis of several clotting factors, including prothrombin. Its deficiency leads to an increase in both PT and PTT.

DIC: Disseminated intravascular coagulation is a complex condition in which the coagulation system becomes overactive, leading to depletion of clotting factors and platelets and an increase in PT and PTT.

Heparin therapy: Heparin is an anticoagulant that prolongs both PT and PTT.

Hemophilia: Hemophilia is an inherited bleeding disorder that leads to deficiency or dysfunction of clotting factors, resulting in increased PT and PTT.

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When taking a patient's history, the component that would reveal information about illnesses such as cancer or heart disease is the "Past Medical History" (PMH).

Past Medical History is a crucial component of a patient's history because it covers the patient's previous illnesses, surgeries, hospitalizations, and any chronic medical conditions they may have.

By gathering information about their past medical history, healthcare professionals can identify potential risk factors, recognize patterns, and better understand the patient's overall health status.

Summary: In order to reveal information about illnesses like cancer or heart disease when taking a patient's history, it's essential to focus on the Past Medical History component.

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The simplest way to increase functional residual capacity (FRC) in a post-op patient is through the use of incentive spirometry, which involves the patient taking slow, deep breaths using a device that provides visual feedback on their inspiratory effort.

Incentive spirometry helps to prevent postoperative atelectasis, which is a common complication following surgery that can lead to hypoxemia and respiratory distress. By encouraging deeper breaths, incentive spirometry can increase lung volume and improve oxygenation.

Other measures that may help to increase FRC in a post-op patient include early mobilization, the use of positive end-expiratory pressure (PEEP) ventilation, and appropriate pain control to encourage deep breathing and coughing.

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One intervention that the school nurse could implement  is to provide education on healthy eating habits and physical activity.

The school nurse could work with teachers and parents to develop and implement programs that encourage healthy eating, such as providing healthy snack options and promoting drinking water instead of sugary drinks. Additionally, the school nurse could work with physical education teachers to promote physical activity and provide opportunities for students to participate in exercise programs or sports teams.

The nurse could also provide individual counseling and support to students who are struggling with weight issues and connect them with community resources such as dietitians or physical therapists. By implementing these interventions, the school nurse can help to improve the health and well-being of children and adolescents, reducing the prevalence of obesity and its associated health risks.

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When a large volume of air is needed at a diaphragm, the thermostat may feed branch line pressure to the Pilot positioner.

In heating, ventilation, and air conditioning (HVAC) systems, thermostats are used to control the temperature in a space by turning on or off a heating or cooling system. Thermostats can also be used to regulate other components in HVAC systems, such as the volume of air flowing through a duct or the position of a valve.

When a large volume of air is needed at a diaphragm, the thermostat may feed branch line pressure to the pilot positioner. This positioner is responsible for controlling the opening and closing of a control valve, which regulates the flow of air to the diaphragm.

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The glomerulus is the primary site for blood filtration in the kidneys.

The glomerulus is a network of tiny blood vessels called capillaries that are surrounded by a double-layered capsule called the Bowman's capsule.

As blood flows through these capillaries, pressure forces water, salts, and waste products out of the blood and into the Bowman's capsule, forming the initial filtrate.

This filtrate then travels through the rest of the nephron, where various substances are reabsorbed or secreted to produce the final urine.

Summary: Blood is initially filtered in the kidneys through the glomerulus, which is a network of capillaries within the Bowman's capsule. This filtration process forms the initial filtrate that will be further processed by the nephron to produce urine.

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When caring for a 90-year-old client who has fractured the proximal end of their right femur and requires an internal fixation device, a nurse should consider several general facts about older adults.

Firstly, elderly patients typically have a slower healing process due to age-related changes in tissue repair and reduced blood supply to the affected area. This may prolong recovery time and require additional monitoring.

Secondly, older adults are at a higher risk of developing complications such as infections, blood clots, and pneumonia. The nurse should closely monitor the patient's vital signs, wound site, and mobility to prevent these complications.

Thirdly, older individuals often have multiple comorbidities that can impact their overall health and response to treatment. The nurse should be aware of the patient's medical history and coordinate care with other healthcare providers accordingly.

Lastly, elderly patients are more prone to experiencing confusion, delirium, and disorientation, especially in unfamiliar environments like hospitals. Maintaining a consistent daily routine, providing clear explanations, and involving the patient in decision-making can help reduce confusion and promote a sense of control.

Therefore, the nurse should focus on close monitoring, preventing complications, coordinating care, and addressing the unique needs of older adults during the recovery process.

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