Prior to recommending a medication to their patients, scientists should acquire information regarding the medication's efficacy and drug's safety.
What does a drug's safety mean?Painkiller safety refers to the incidence of adverse drug side effects that are treatment emergent, meaning that they appear during therapies and were present before treatment, or that they get worse during treatment compared to pretreatment (i.e., physiological or science lab toxicity that can conceivably be related to the drug).
What are drug efficacy and safety?Undoubtedly, a medicine (or any other type of medical treatment) should only be administered when a patient will benefit from it. Benefit evaluates the drug's effectiveness in achieving the targeted outcome as well as the kind and propensity of any negative side effects (safety).
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a hospice nurse has developed a care plan for a client with liver cancer. the care plan focuses on providing palliative care for this client. the goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means?
Through aggressive management of symptoms, the goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life. Thus, the correct option is A.
What is Palliative care?Palliative care is the interdisciplinary medical caregiving approach which is aimed at optimizing the quality of life and mitigating the suffering among people with serious, complex, and often terminal illness.
The main goals of Palliative care are as follows:
1. Relieve pain and other symptoms.
2. Address emotional and spiritual concerns, and those of the caregivers.
3. Coordinate care of patient.
4. Improve the quality of life during illness.
Therefore. the correct option is A.
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Your question is incomplete, most probably the complete question is:
A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means?
A. aggressive management of symptoms
B. treatment of the disease process
C. eliminating all forms of medical and nursing care
D. providing counseling related to the stages of death and dying
a 22-year-old daycare worker comes to the clinic for evaluation of fever as high as 103 that 5 degrees fahrenheit, headache, and neck pain. she has photophobia and neck stiffness. during the physical examination, you flex the patient's leg at both the hip and the knee and then straighten her knee to elicit meningeal irritation. the patient experiences severe pain. the name of this sign is
According to the given statement the patient experiences severe pain. the name of this sign is Kernig's sign.
How can I tell whether my headache ?Your headache is intense or explosive when it first begins. Even though you frequently experience headaches, this one is "the worst ever." You may also experience confusion, memory loss, loss of coordination, impaired vision, difficulties moving your wrists and ankles, and design defects in addition to your headache. Throughout the day, your headache gets worse.
How does a headache caused by Covid feel?Some of the distinctive characteristics of a COVID-19 headache, according to researchers, include: pulsating, pushing, or stabbing in nature. occurring on both sides (across the whole head) strong pressure that won't go away even taking common painkillers like acetaminophen and ibuprofen.
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Manuel experiences high levels of anxiety about exposure to germs. As a result, he typically washes his hands more than 100 times a day. What is the clinical term for this behavior?.
Hand-washing compulsives are preoccupied with contamination and wash their hands until they are chapped, rough, and sometimes bleeding. It is called obsessive compulsive disorder.
What is OCD?A prevalent mental health issue known as obsessive compulsive disorder (OCD) is characterized by a person's having obsessive thoughts and engaging in compulsive behaviors. OCD can afflict everyone, regardless of gender or age. Although it can begin earlier in life for certain people, typically around the time of puberty, the majority of people don't have symptoms until they are young adults.
Those who suffer from hand-washing compulsions are preoccupied with the idea that they might be spreading germs to others, and as a result, they frequently wash their hands until they become sore, chapped, and even bleed.
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a patient is on a ventilator and is sedated. what care may the nurse delegate to the unlicensed assistive personnel (uap)?
A client is on a ventilator and is sedated, then the nurse must delegate to the unlicensed assistive personnel to : assess pain and sedation needs, and also monitor the patient’s blood pressure every 2 to 4 hours.
What should be the care of a client on a ventilator?When UAP enters the patient's room, the/she should take vital signs, check oxygen saturation, listen to breath sounds, and note changes from previous findings. Also assessing the patient's pain and anxiety levels is very important. Make sure to read the patient's order and obtain information about the ventilator.
85% of intensive care unit (ICU) patients are given intravenous sedatives to help attenuate the anxiety, pain, and agitation associated with mechanical ventilation.
When the patient is on ventilator and sedated then review communications with the family members and also keep a check on ventilator settings and modes.
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which nursing intervention would assist in the management of the liver failure client with a nursing diagnosis of alteration of sensory perception and thought processing?
Supporting body systems, managing warning signs and symptoms of decreased liver function, and preventing worsening cerebral edema are the main nursing care goals for patients with liver failure.
What is liver failure?Some liver conditions can be managed with lifestyle changes, such as giving up drinking or decreasing weight, usually as part of a medical plan that also includes continuous liver function monitoring. Other liver issues can need surgery or drug treatment.
To stop liver illness are Consume alcohol sparingly. That entails up to one drink per day for women and up to two drinks per day for males for healthy individuals. More than eight drinks per week for women and more than 15 drinks per week for males is considered heavy or high-risk drinking.
The best specialists for this job are gastroenterologists and hepatologists. If your condition is severe enough, you might need a liver transplant performed by a transplant hepatologist.
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in 2014, what infectious agent was responsible for the largest epidemic in history and was spread to the united states by healthcare workers employed in west africa?
The infectious agent that was responsible for the largest epidemic in history and was spread to the U.S. by the healthcare workers employed in West Africa is the Ebola virus.
Ebola is a type of virus belonging to the family of Filoviridae. There are five subtypes of this virus, named after the location in which it was identified first:
ZaireBundibugyoRestonSudanTai ForestThe Ebola virus spread through contact with bodily fluids, such as blood, feces, vomit, and semen. It can also be spread through contaminated objects and deceased victims. The fatality rate of Ebola during outbreaks can be as high as 90%, making it very dangerous.
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the nurse is preparing to administer intravenous mgso4 (magnesium sulfate) to a multipara who has been admitted for pre-term labor. what are the initial side effects that are expected to occur with the bolus dose that the nurse should explain to the patient?
The initial side-effects of the bolus dose that are expected to occur when intravenous MgSO₄ is administered to a multipara admitted for pre-term labor are: Flushing, sweating, and irritability.
Bolus dose is defined as the certain amount of drug or medication administered to a person within a specific range of time. The amount of a bolus dose is generally high in order to increase the levels of the medication in the blood for the current time.
Pre-term labor is the condition where regular contractions occur in the uterus resulting in the opening of the cervix between to 20th- 37th week of pregnancy. The pre-term labor results in pre-mature birth of the baby.
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what is the ultimate future state for a health care system called when an integrated approach to improve care, improve population health and lower health care costs have been achieved?
Triple Aim is the ultimate future state for a healthcare system when an integrated approach to improve care, improve population health and lower healthcare costs have been achieved.
How does integrated healthcare work?Integrating the physical, emotional, behavioral, and financial facets of healthcare, integrated healthcare is a collaborative approach to patient treatment. The objective is to offer comprehensive treatment and prevention for a variety of chronic illnesses.
The multidisciplinary nature of integrated healthcare systems necessitates close coordination and information exchange across all of the major participants in a patient's care as opposed to the compartmentalized approach of traditional healthcare. It contains health experts from a variety of disciplines, including physicians, nurses, behavioral psychologists, therapists, and even navigators for health insurance.
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the nurse is taking care of a client who is scheduled for a mastectomy. the client tells the nurse that the client is apprehensive about the operation and asks the nurse to read a passage from the koran to help prepare the client for surgery. which action by the nurse is the most appropriate?
Read the Koran passage to the client is the action by the nurse is the most appropriate.
What types of tasks does a nurse perform?Registered nurses (RNs) administer and supervise patient care, educate the public about different health issues, and provide psychological support and counseling to patients' relatives. The majority of nurses work together along with physicians and other medical professionals in a wide range of settings.
How many years do nurses live?Individuals with access to formal health education as having a nurse or doctor in the relatives 10% less likely to survive beyond the age of 80, according study released in a journal article by the Institute of Economic Analysis.
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a client is unable to externally rotate the left shoulder. what health problem should the nurse suspect is occurring with this client?
the nurse is examining the laboratory results of a client with lactic acidosis whose ph is 7.35. which mechanism(s) has contributed to the ph being within normal range? select all that apply.
The normal range of pH during lactic acidosis can be maintained by: sufficient intake of fluids, hemodialysis with bicarbonate ions, adequate amounts of oxygen in the body, etc.
Lactic acidosis is the condition where the body wither produces excessive lactic acid or is not able to use the lactic acid efficiently. The causes for this condition can be different like over-exercise, kidney, heart or liver disorders, alcohol addiction, etc.
Hemodialysis is the artificial method of filtering blood using a machine called dialyzer. Dialyzer is said to be the artificial kidney. In lactic acidosis, bicarbonate ions are added to the purified blood because their level falls down during the condition.
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the health care practitioner is demonstrating to the client how to instill ophthalmic drops. she reviews proper hand-washing and handling of the medication. what other instruction does the health care practitioner need to explain regarding the procedure?
The health care practitioner is demonstrating to the client how to instill ophthalmic drops. she reviews proper hand-washing and handling of the medication. Ointment.
"Ophthalmic drops" is a time period every so often used to explain liquid eye drops. those eye drops are used to deal with situations, inclusive of eye infections, eye hypersensitive reactions, and corneal ulcers.
Ophthalmic anti-infectives are anti-infectives contained in a product formulated specially to be instilled or carried out in the eye or eyes. Ophthalmic anti-infectives encompass eye drops, gels, or ointments. Anti-infectives are drugs that could both kill an infectious agent or inhibit it from spreading.
This medication treats the simplest bacterial eye infections. it'll no longer paint for other sorts of eye infections (including infections due to viruses, fungi, and mycobacteria). useless use or misuse of any antibiotic can result in its decreased effectiveness.
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a patient in the emergency department sustained a knife wound to the abdomen. the wound extended through the membranes surrounding the large intestine, into the layers of the large intestine, and into the lumen of the large intestine. discuss the membranes and layers that were penetrated, from superficial (outermost) to deep (innermost).
The membrane and sections that were pierced from the surface to the depths (innermost).
What's within the abdomen?The stomach, the jejunum and ileum of the small intestine, the colon of the large intestine, the liver, the brain, the liver, the thyroid, the uterus, the reproductive organs, the eggs, the kidneys, its vas deferens, the bladder, and numerous blood vessels are all located in the abdomen (arteries and veins).
What use does the abdomen serve?Breathing, digestion, posture, equilibrium, and movement are the main purposes of the abdomen. The abdomen contains all of the key organs involved in digesting. The auxiliary muscles of breathing rely heavily on the abdomen for breathing.
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which is not a compensatory behavior for someone with bulimia? a.use of diuretics b.excessive exercise c.liquid-only diet d.forced vomiting
Which is not a compensatory behavior for someone with bulimia is... C. A liquid-only diet
Bulimia nervosa is an eating disorder in which the sufferer has the desire to eat large amounts of food at once. During these episodes of eating, the person with bulimia has no control over stopping them. Then, after consuming the food, the sufferer will feel embarrassed, so he wants to do everything he can to get rid of the food he had consumed earlier.
Bulimia can cause serious complications and can even be a danger. The frequent frequency of vomiting can damage teeth due to stomach acid and trigger swelling of the salivary glands. It can also cause a sore throat and bad breath.
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obtaining a sterile urine specimen from a client's indwelling urinary catheter. during the procedure, the nurse should
With an alcohol wipe. The nurse clamps the catheter drainage tubing to collect a urine specimen from a client's indwelling urinary catheter.
What is indwelling urinary catheter ?"Indwelling" means to be physically present. Using this catheter, your bladder empties its contents into a bag that is carried outside of you. Urinary incontinence (leakage), urinary retention (inability to urinate), necessary surgery, or another medical condition are common causes of an indwelling catheter.
An alcohol swab should be used to clean the catheter's sample port. After drawing 10–30 mL of urine from the catheter's sample port using the Luer-lock syringe, remove it and unclamp the tubing. Open the sterile container's lid, inverting it onto the drape to preserve sterility, and then close it again.Learn more about Indwelling urinary catheter here:
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what home care instructions would be given to a patient with a provisional restoration? group of answer choices do not brush or floss the restoration. brush but do not floss the restoration. brush and floss the restoration as you would any other tooth. brush and floss the restoration, sliding the floss through the cervical embrasure.
Home care instructions would be given to a patient with a provisional restoration is to brush and floss the restoration, sliding the floss through the cervical embrasure.
Provisional restoration is a temporary filling of a ready tooth till permanent restoration is allotted. it's wont to cowl the ready a part of the tooth, so as to take care of the occlusal area and also the contact points, and insulation of the pulpal tissues and maintenance of the periodontic relationship.
In a perfect smile, teeth are aligned during a swish row with every tooth touching the tooth next thereto and healthy gum tissue in between. The place wherever the teeth bit one another is termed the “contact” and also the space below the contact is termed the “embrasure”
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nurses are occasionally asked to witness a testator's (person who makes the will) signing of a will. which guideline is true regarding a nurse's role in witnessing a testator's signature?
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of a will and the guideline which is true regarding a nurse's role in witnessing a testator's signature is Witnesses to a signature do not need to read the will.
Witnesses to the signature on a can don't got to scan it, however they ought to take care the document being signed could be a can and not another document. Witnesses ought to watch the someone sign the need, and that they ought to register the presence of every alternative. A beneficiary to a can isn't allowed to act as a witness in most states. 2 or 3 witnesses are most typically needed on a will.
The question is incomplete, here is the complete question
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which of the following guidelines is true regarding a nurse's role is witnessing a testator's signature?
a) Witnesses do not need to observe the signing of the will and can sign it at a later time.
b) A beneficiary to a will is allowed to act as a witness.
c) A single witness is sufficient for a will.
d) Witnesses to a signature do not need to read the will.
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the nurse is caring for a client with a chest tube drainage system and notes constant bubbling in the water seal chamber. which nursing action is appropriate?
Full Question :The nurse is caring for a client with a chest tube drainage system. The nurse notes a fluctuating water level on inspiration and expiration in the submerged tube in the water seal chamber of the chest tube drainage system. Which nursing action is appropriate?
1.Suction the client.
2.Increase the suction.
3.Document the findings.
4.Encourage coughing and deep breathing
The nurse action 3.Document the findings
What is chest tube drainage system ?
A chest tube drainage system is a sterile, disposable device that has one or more chambers and a compartment system with a one-way valve to evacuate air or fluid from the patient and prevent it from entering the patient again.
A chest tube drainage system with three chambers, including a water seal, suction control, and drainage collection chamber, is a chest drain, also referred to as an under water sealed drain (UWSD).
A chest drainage system (CDS) is connected once a chest tube has been inserted. The four primary types of CDS are one-way Heimlich valves, analog three-container systems, digital or electronic CDS, and simple vacuum bottles.
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the nurse is assigned to administer medications to a patient on a unit that has just implemented bar-code medication administration (bcma). which step is proper for the nurse to follow?
If a nurse is tasked with giving medication to a patient on a unit that has just begun using bar-code medication administration (BCMA), the right course of action is for the nurse to scan the patient's ID, the nurse's ID, and the code on the medication package (option c).
To guarantee that the right medication is administered to the right patient, the BCMA system scans the IDs of the nurse, the patient, and the pharmaceutical package. It would be unacceptable to ask the patient for their address or for two random IDs that they might not be aware of. The right way to administer medication is to open the packages at the patient's bedside. In order to verify that the medication is the right one, scanning devices must be used with the medication still inside the package.
Hospital prescription medication delivery is automated using barcodes using the Barcoded Medication Administration (BCMA) inventory control system. By electronically authenticating and documenting drugs, BCMA seeks to ensure that patients are receiving the appropriate prescriptions at the appropriate times. The data contained in barcodes makes it possible to compare the medication being given to the patient to what was prescribed for them.
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Complete question:
The nurse is assigned to administer medications to a patient on a unit that has just implemented bar-code medication administration (BCMA). Which step is proper for the nurse to follow?
a. Open the medication packages at the nurses' station.
b. Ask the patient to verify his or her address.
c. Scan the nurse's ID, the patient's ID, and the code on the medication package.
d. Ask the patient to name two patient identifiers.
If you want to check for consecutive myocardial infarction, which lab value is the most effective?.
A coronary heart assault, also called a myocardial infarction, takes place while a part of the heart muscle would not get sufficient blood. The more time that passes with out treatment to restore blood flow, the more the damage to the coronary heart muscle. Coronary artery sickness (CAD) is the primary purpose of coronary heart attack.
A heart attack (medically known as a myocardial infarction) is a lethal medical emergency in which your coronary heart muscle starts offevolved to die as it isn't always getting sufficient blood waft. A blockage in the arteries that deliver blood in your heart generally causes this.
Probabilities of survival depend on the severity of the myocardial infarction. in step with latest studies, large heart attack survival costs are low, but the survival price after coronary heart assaults in hospital care is between ninety% to ninety seven%.
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two days following a colon resection, an elderly client shows new onset of confusion. when contacting the health care provider, the nurse should make which recommendation?
Two days following a colon resection, an elderly client shows a new onset of confusion. when contacting the health care provider, the nurse should recommend, "Shall I collect and send a urine sample for culture and sensitivity?". This makes option 3 the right answer to the question.
What is confusion?A colon resection is an operation done to remove part or all of a client's colon due to an incurable disease or other health conditions which affect parts of the colon or put other parts at risk.
Some conditions like cancer of the colon would require a colon resection. In summary, sending a urine sample for culture and sensitivity, would allow the nurse to find the cause of the confusion.
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The missing part:
Two days following a colon resection, an elderly client shows a new onset of confusion. When contacting the healthcare provider, the nurse should make which recommendation?1. "Do you want a CT scan to rule out stroke?"2. "May we have a prescription for restraining this client?"3. "Shall I collect and send a urine sample for culture and sensitivity?"4. "Would you like a stat potassium level done?"
the nurse has attended morning report on a busy medical unit. the nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock?
Patients to be at greatest risk for the development of cardiogenic shock are the patients admitted following a myocardial infarction.
Cardiogenic shock may occur after a myocardial infarction when a large area of myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. While patients having acute renal failure are at risk for dysrhythmias while patients experiencing a stroke are at risk for thrombus formation, the patient admitted following an myocardial infraction is at the greatest risk for development of cardiogenic shock as compared to the other diagnoses. Older age can also contribute to the cardiogenic shock. blockages (coronary artery disease) in several of your heart's main arteries can also cause cardiogenic shock.
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what data would be significant to obtain when performing a focused genitourinary history of a patient?
The gathering of subjective information regarding the patient's food and exercise regimen is part of a focused gastrointestinal and genitourinary assessment.
Which one is more accurate, focused or both?Useful hints. While more prevalent in the UK and Australia, its spelling focused is far more frequent in the US. The spelling focused is described as irregular in the Oxford English Dictionary. Focused is a commonly used spelling in the UK, but prestige media tend to use focused more frequently (focuses, focusing).
How would one who is focused be described?People that are truly focused always have a plan in place. They know exactly where they're heading and have a solid plan for get there. Create a well-defined path to achieve your goal. It doesn't need to be complex.
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a client who is taking an ace inhibitor informs the nurse that she is considering having a child. what information should the nurse provide to the client related to this new information?
Based on research, the correct answer is that the nurse should inform the client who is taking an ACE inhibitor that these inhibitors are contraindicated during pregnancy, putting the pregnancy at risk.
What is an ace inhibitor?They are agents that act by inhibiting the conversion enzyme (kininase II), which converts angiotensin I to II, and are used as hypotensives and, in low doses, for the treatment of heart failure.
In this sense, these inhibitors during the first trimester of pregnancy should be avoided as they can induce malformations or abnormalities of an anatomical or functional nature in the second or third trimester of pregnancy.
Therefore, we can conclude that the nurse should explain to the client that ACE inhibitors should not be used during pregnancy due to the risk of a birth defect.
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The world health organization has said that _______________ is single greatest biggest health threat facing humanity.
The world health organization has said that climate change is single greatest biggest health threat facing humanity.
The WHO is a specialized employer of the United countries responsible for worldwide public fitness. The WHO constitution states its most important goal as the attainment with the aid of all peoples of the highest possible level of fitness.
WHO works international to sell health, hold the sector secure, and serve the vulnerable. Our goal is to make certain that a thousand million more human beings have conventional fitness insurance, to shield one billion extra people from fitness emergencies, and provide a similarly billion people with higher fitness and nicely-being.
The WHO sets requirements for disease manage, fitness care, and medicines; conducts schooling and studies programs; and publishes scientific papers and reports. a major aim is to enhance get right of entry to to fitness care for people in growing nations and in groups who do now not get appropriate fitness care.
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a nurse examines the external genitalia of a client and observes that the scrotum is underdeveloped and the testis cannot be palpated. how should the nurse document this condition?
Assessment, planning, execution, and evaluation of care should be included in the nursing record. Ensure that the record begins with a cover sheet. This comprises the patient's personal information, including name, age, address, next of kin, and caregiver. All continuation papers must have the full patient name.
Documentation in nursing is vital for effective clinical communication. Appropriate documentation offers an accurate reflection of nursing evaluations, changes in clinical status, treatment provided, and essential patient information in order to assist the multidisciplinary team in providing excellent care.
From the observes, the condition is called cryptorchidism. It is the failure of one or both testicles to descend from the abdomen into the scrotum. A testicle that has not shifted into its appropriate position in the sack of skin hanging below the scrotum before birth is undescended (cryptorchidism). Typically, only one testicle is injured, however in approximately 10% of cases, both testicles remain undescended.
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which assessment will a nurse pereform before administering streptomycin to a patient for tuberculosis
Assessment a nurse will perform before administering streptomycin to a patient for tuberculosis are:
Assess hearing status.Review creatinine clearance.Review complete blood count.Mycobacterium tuberculosis is the bacteria that causes tuberculosis (TB). Although TB germs typically assault the lungs, they can also affect the kidney, spine, and brain.
Since streptomycin can be harmful, the patient's hearing condition is examined. If the patient has hearing loss, the nurse should refrain from giving the patient streptomycin. Because streptomycin might cause drug-related hematologic problems, the nurse should evaluate the patient's complete blood count result. Because streptomycin (Streptomycin) causes nephrotoxicity, the patient's creatinine clearance test result is evaluated. If the patient has a patient with compromised renal function, the nurse should avoid giving the patient streptomycin. The nurse should refrain from giving streptomycin if the patient has hematologic issues.
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What is the difference between a secondary immune response occurring without a vaccine compared to the same response occurring after a vaccine?.
Without vaccination, the immune system can more quickly and effectively rid the body of the antigen that was met during the initial invasion during the secondary immune response. Vaccination makes use of this secondary response by exposing the body to the antigens of a specific pathogen and activating the immune system without actually producing disease.
The purpose of vaccinations is to prepare the body so that when a person is exposed to the disease-causing organism, their immune system will be able to respond quickly and with high activity, killing the pathogen before it causes sickness and lowering the chance of transmission to others.
This means that after vaccination, the immune system makes use of the secondary immune response by exposing the body to the antigens of a specific pathogen. Without the vaccine, the immune system can destroy the antigen during the secondary immune response.
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a nurse is learning about family structures. what does the nurse understand a holistic definition of a family to be?
The holistic definition of family for nurses is two or more individuals who provide physical, psychological, economic, or spiritual support to one another and may or may not be related by blood.
Holistic is one of the concepts that underlie actions which include physiological, psychological, sociocultural, and spiritual dimensions. These dimensions are a unified whole, if one dimension is disturbed it will affect the other dimensions. Holistic nurses help patients to take responsibility for their health by acting as health role models who integrate self-care into life and practice it in everyday life.
Family nursing is the art and science, philosophy, and way of interacting with families about health care. Family care is important in health care units where a nurse must regard the family as a unit.
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a client is prescribed salmeterol. the nurse would expect this drug to be administered by which route?
Salmeterol is available as a dry powder that must be inhaled orally through a specialized inhaler. When is salmeterol used to treat COPD or asthma
Tell us about asthma?A consequence of asthma is lung damage. It also triggers recurrent coughing fits, dyspnea attacks, tightness in the chest, and wheezing. Asthma can be controlled with medication and by staying away from situations that might cause an attack.
Is asthma treatable?Unfortunately, asthma has no known treatment. As a result, you might get asthma symptoms after being exposed to triggers. Even if you don't experience symptoms frequently, this is the situation. Your therapy will rely on two factors: the severity of your asthma and how frequently you experience symptoms. Your triggers may change over time.
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