Immunity Day 2

The speaker discusses various types of pneumonia, including community-acquired, healthcare-associated, hospital-acquired, ventilator-associated, and aspiration pneumonia. They provide information on the pathophysiology, risk factors, signs and symptoms, and nursing interventions for each type of pneumonia. They also mention the importance of oxygenation and the use of antibiotics in treatment. This is pneumonia, sinusitis, trauma, sprain, and osteomyelitis. I looked at almost everybody's questions. There's one I'm going to go back and look at. And then if I feel like I need to address it, we'll check it. Okay? Any questions up in there? No? Okay. Alright, pneumonia. Pneumonia is the inflammation of the lungs, the paroxysmae caused by various microorganisms, including bacteria, micro-bacteria, fungi, and viruses. Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose a patient at risk for micro-bowel invasion. Acute infection of the pulmonary tissue that occurs in gas exchange and is classified by ecology, location in the lung, or type. Alright. Pathophysiology of it. Arginine enters the upper airway and multiplies. It's followed by the spread to the lungs via secretions of blood. Gel-like substance forms as microorganisms and phagocytes. Cytic cells break down. Pneumonia affects both ventilation and diffusion. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normal air-filled spaces. Did I need to repeat that? White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normal air-filled spaces. The agent can be infectious. It can be bacteria, virus, and the fungus. Four factors of pneumonia. Community-acquired pneumonia occurs either in a community setting or within the first 48 hours after hospitalization or being in an institutionalization. So what do we mean by institutionalization? In a home, in a place, what do we mean by it? Like an LTAC or even being in a prison because you didn't pose a threat to somebody else. Healthcare-associated pneumonia is pneumonia in a non-hospitalized patient who had a significant experience with a healthcare system in a recent past. That kind of explains itself. You are not going to somebody's room where we get pneumonia from or in the elevator or whatnot. On outpatient treatment, hospital or dialysis treatment in a clinic within the past 30 days or hospitalized in an acute care hospital in the past 90 days, it is caused by a multidrug-resistant pathogen. Identification of this type of pneumonia in the ER is crucial because it is difficult to treat and the initial antibiotic treatment must not be delayed. The antibiotic used in a healthcare-associated pneumonia is different from a community-acquired pneumonia because the pathogen is multidrug-resistant. I need to repeat anything? Okay, hospital-acquired pneumonia develops 48 hours or more after admission to the hospital institution or does not appear to be incubated during admission. The ventilator-associated pneumonia occurs when endotrachea-intubated patient. Unfortunately, that happens a lot. All right, aspiration pneumonia is caused by the entry of exogenous or endogenous substance into the lower airway. With the hospital-acquired pneumonia, certain factors may predispose patients to hospital-acquired pneumonia because of the impaired host, which means those severe acute or chronic conditions such as coma, malnutrition, prolonged hospitalization, hypotension, and metabolic disorders. The hospital-acquired pneumonia is caused by the entry of exogenous or endogenous substance into the lower airway. Prolonged hospitalization, hypotension, and metabolic disorders. With your ventilator-associated pneumonia, it occurs within 96 hours of being on mechanical ventilation. And it's usually due to an antibiotic-sensitive bacteria. With aspiration pneumonia, substance other than bacteria may be aspirating into the lungs such as gastric content, exogenous chemical content, and irritating gases. One good example is your patient comes back from surgery and they're instigated and they're not moving around, they're laying there. So that's how they can develop pneumonia from that. So the chemical is still sitting in their body. But you have to move the patient out of there. Most common organisms for both community-acquired and hospital-acquired is gram-positive bacteria and streptococcus pneumonia. Most common organisms for both community-acquired and hospital-acquired is gram-positive bacteria, streptococcus pneumonia. Can you repeat anything? Alright, community-acquired pneumonia. So what are some risk factors for community-acquired pneumonia? So age. Older than 65 years. Alcoholism. Immune-suppressive disorder. Having multiple medical comorbidities. Exposure to a child in a daycare facility. In a long-term care facility, resident in a long-term care facility. And corticosteroid therapy. And malnutrition. Are you a herpeto? Anybody? No? Okay. Corticosteroid therapy. And malnutrition. And malnutrition. And malnutrition. Alright. Hang on, hang on. Hold on, hold on. Alright. Let's make this a bunch. So pneumonia is caused by casual organisms such as streptococcus, hemophilius, legendale. I gave you pages on there. Check it out, look at it. Conditions that produce mucous or bronchial obstructions, such as smoking, COPD, cancer, immune suppression, prolonged mobility, and shallow breathing. Some of our signs and symptoms include sudden onset of chills, rapidly rising fever, periodic chest pain that is aggravated by deep breathing and coughing, tachypedia, shortness of breath, use of accessory muscles, environmental pneumonia, you have mycoplasma infection, or infection with lingual geneal organisms that may be post-temperature deficit, which is the pulse is slower than expected for a given temperature. Some patients may exhibit upper respiratory infection. Some patients may exhibit upper respiratory infection. So on your nursing intervention, remember we're trying to improve the airway pain of our patient, because that's the problem, right? So we want to remove the secretions, because if we don't, retained secretions interfere with the gastric sac. Encourage hydration of two to three liters a day. I'm seeing a lot of, when I put on your toxic mask, be specific to how much you're talking about you want your patient to have, because there will be times somebody will ask you how much should they have, because you can overload somebody's system. So you kind of need to know, you need to know how much. All right. Adequate hydration thins and loosens the pulmonary secretions. Number three, immunification may be used to loosen secretions and improve ventilation. Forced coughing may be initiated, either voluntarily or by reflux. Lung expansion maneuvers, such as deep breathing with a synchrometer, may induce a cough. So before we give an antibiotic, what should we do? What type of sample? And if best, you can early morning. All right. Number five. Depressed cough reflects due to medication. Our other signs and symptoms are, which were upper respiratory tract infection. Number 10, predominant symptoms may be headache, low-grade fever, parotid pain, myalgia, rash, pharyngitis. You can always expect to find a yellow, green, pink sputum. After several days, you can get sputum late, which you shouldn't be. In severe pneumonia, there will be flushed cheeks, and the lips and nail beds will demonstrate. Central stenosis, which is a late sign of poor oxygenation. So, let me tell you all a funny story. My grandfather used to have kind of club fingers. For some reason, I do not know why, I was like, man, all my fingers look like they work. I just associated that with working and age. Didn't realize he had that because he smoked. You know, he wasn't getting high. Okay. Let me tell you why we're scared. I didn't. I literally didn't. It didn't happen. I keep my nails done. So, one of the key things you need to remember about pneumonia is oxygenation is never long-term. Never long-term, okay? Some of the nursing interventions will be chest physiotherapy, which is percussion and postural drainage. I can be honest. I've only done it maybe once or twice. I've only done it twice, I believe. Consult respiratory therapists for secretion management protocols. Remove sputum by nasal trachea suction if patient is weak to cough. Is too weak to cough. Administrate and titrate oxygen therapy by protocol. So, when we do the physical therapy percussion, what is that for, the chest psychotherapy? What do they do? Looking for. All right. Also, on chest x-ray, PHIM shows that a low bar of thick segmental consolidation. And consolidation occurs when the normal airfield spaces of the lungs are filled. So, you will see like a dent on x-ray exam. Questions? Concerns? Move on. Okay. On additional signs and symptoms, you will have the arthropenia, shortness of breath when reclining or in the supine position. Preference to be propped up or sitting in a bed. Leaning forward. You can also speak for appetite. Apheresis. Easily tired. Superlative sputum. Rusty blood veins. Sputum maybe is basic. And strep or coccyx. Coccyx. So, when we're doing ADMs, how do we want to teach our patients so they don't get so tired? We're already using a lot of oxygen. But what do they have? What do we teach our patients? What do we want them to do? Yeah. So, we call it kind of like cluster care. So, we want to do small little increments of ADM. This is what we want to do in clusters. Not everything all at once. We're going to time out. And I'm going to leave you all with that. Okay? Avoid over-insertion. And this is due to possible extubation of symptoms. So, some of our nursing interventions is encourage rest. Like I said, avoid over-insertion. Keep patient in semi-followed position and change position frequently. Promote fluid intake. And tachyphena turns as compensatory mechanism for fever and labor breathing, thereby increasing insensible fluid loss during expiration. So, we want to have them intake at least two liters a day. Unless they have some other disease where they should be taking that medicine. 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Before initiating internal soup feeding, confirm the tip location. For a patient receiving soup feedings, assess the function of the feeding tube at 4-hour intervals. Assess for gastrointestinal residue to the feedings at 4-hour intervals. For a patient receiving soup feedings, avoid both feedings and end those at high risk for aspiration. Consult with a primary care provider about obtaining a swallowing evaluation before or after feedings are started for patients who were recently intubated or were previously intubated for more than two days. Next one. Alright. Next one. So when I talked about on x-ray what it would look like, that's exactly what it would look like. So smoke reduces immunity, increases the risk of smoking, and induces pneumonia. Studies have shown that there is a dysfunctional immune system among smokers, as evidenced by hypothermia airway wall. For the purpose of patient teaching, smoking reduces immunity and increases the risk of smoking and induced pneumonia. I hear yawning. I might need to go. Next one. Pneumonia is an acute inflammation of the lung, mostly as a result of infection, and is the most common cause of infections to be detected in humanity today. The underlying infection causing pneumonia can be extremely varied. For example, bacteria and viruses are the most common, but also fungi and even parasites are possible. In those cases, the specific microbe responsible for the pneumonia is not found, but because similar pathogens are found in certain viruses. Pneumonia generally gets divided into categories. The reason this is useful is because by knowing the environment, and therefore the likely microbes the patient will be exposed to, treatment can be taken to cover those microbes. Pneumonia is usually acquired at the time the pneumonia develops outside of a hospital setting, and the bacterial causative agents are divided into typical and atypical. It is commonly used to stress the cause of pneumonia, also known as pneumococcus, as well as pneumococcus influenzae on the typical side, and chlamydiae pneumoniae, or myococcus pneumoniae, on the atypical side. The most common violations are respiratory conditions such as asthma virus, influenza, pneumonia disease, and pneumonia virus. Chlamydiae can also cause CACS, but this is more common in immunocompromised people. CACS may also include healthcare facilities such as immunization centers that were previously in a category known as Healthcare Associated Pneumonia. Hospitals where pneumonia is defined as developing more than 48 hours after admission to hospital, and Healthcare Associated Pneumonia when it develops more than 48 hours after intubation, similar agents cause these to include E. coli, pneumonia, and bacterial causes for it. Aspiration pneumonia occurs when external content is introduced to the lung environment that detects the presence of deformities or the use of a gaseous reagent. The myococcus pneumoniae is similar to those in CACS and ASS. Activities are often introduced into the airway and lungs through the airway. But there are defense mechanisms like coughing, or proteases and salivary IDAs in the upper airway, and severe suffocation and leukaemia like alveolar macrophages in the lower airways that prevent infection. Pneumonia occurs when there is a large enough contamination to overwhelm the defenses, or when the system is virulent after being infected. Aspiration pneumonia occurs when there is a large enough contamination to overwhelm the defences, or when the system is virulent after being infected. Aspiration pneumonia occurs when there is a large enough contamination to overwhelm the defences, or when the system is virulent after being infected. The signs and symptoms generally include a cough, which may be productive, or even dry, which is especially the case in the very young or the elderly. There is also typically a fever, but this may also be absent in reality. Disease, malaria, and dyspnea by exertion are other common findings. They may also be chest pains, commonly described as perils, meaning a sharp gain in inspiration and exhalation, and it's important to remember that pneumonia can present important mental suffering in the elderly and in the very young. There is significant overlap between the symptoms despite the underlying infectious agents. Diagnosis includes clinical mystery and suggestive physical impact findings, such as fractals on auscultation or an area of gel percussion, combined with chest x-rays demonstrating infiltrate or areas of consolidation, and perhaps of the alveoli, such as liquid rather than air. Different patterns can be seen depending on the underlying pathology. For example, cats typically have a consolidation of one segmental lobe on the lobe alveoli. Blood tests can help in concerning the presence of inflammatory processes, such as leukocytosis and CID, and procapitalin may be used to help distinguish a bacterial from a viral host. CT imaging can be done in some cases, especially if the diagnosis is uncertain or if the treatment is not working. Looking to exclude fungal pneumonia can help test for a pulmonary embolism. Identification of the underlying pathogen is achieved in under-heart patients, and due to a medical antithesis usually being effective, there is generally no significant benefit in identifying the pathogen. Usually a resistant condition error of bupropyl antigen is readily available, and for these there can't be evidence in those who have not improved on the initial therapy, or in those who have severely done well. Polymerase chain reaction testing can also be an option on the apothermic genose walls or on bronchial alveolar larvae. The mainstay of treatment is empirical antibiotics. Typically for cats, the amoxicillin-productive vitamin, or in some areas, hematolide-like polymerase, can act as an effect on amoxicillin or amoxicillin for options in the non-severe cases. Or, maximizing amoxicillin support out of animals, like mammals, in the severe cases for those with a high resistance risk. Last example also includes the anticoagulant. Newer mid-stage diseases are options in bioimmunogen, caused by anticoagulants. This is usually involved in healthy spread of anticoagulants, but this treatment is not generally recommended in other bioimmunogens. In addition to the anticoagulants, supportive therapies include supplemental oxygen, intravenous fluids, and antipyretics, such as paracetamol. In severe cases, for the respiratory failure, particularly type 2 respiratory failure, then mechanical ventilation may be needed. Okay. My funny little teachers. Put all that information on there. If it moves you, my favorite word is move you. Alright, so let's do some questions. What findings of a nursing assessment will be associated with a diagnosis of pneumonia in an older adult? Come on down. Oh, one. That is correct. Confusion in the older adult is related to hypoxemia, which occurs with pneumonia. The basal dilation and dehydration causes hypotension. The cough is generally a productive cough. Yeah, pretty much on there. Alright, clients with chronic illnesses are more likely to get pneumonia in which of the following situations are present? This one is... No. Which one is it? Did y'all answer? One. What did y'all say? One. One. Real. The reason why it is one, one of the main impacts is the situation like this. This is where they live. Okay? Questions? Alright. Which of the following organisms most commonly causes community acquired pneumonia in adults? Two. Correct. Alright. Y'all must be playing around with the grades. How? The first one is found in hospitals studying pneumonia, and then the third, it don't affect humans at all, is found in cows. Alright, who's reading the questions? Alright. Come on. Who's reading this? Come on, Eli. You're reading the questions? Yes, please. Monitoring a group of clients who are grief-ridden for developing pneumonia. Which of the following clients should the nurse expect to be a risk, like all of your clients? What y'all think? A and B, and what else? Alright, so let's work through this. So the answer is A, B, E, and F. C is incorrect because the patient has to be vaccinated and has a decreased risk to acquire pneumonia. D is the patient has a decreased risk of developing pneumonia. The patient is not on ventilation. And then we've got the other two. The other two are correct. E and F. Any questions about the science? It's A, B, E, and F. A because aspiration, B because pneumonia suppression, E because head injury, and F because head injury and ventilation. Correct. Alright. A nurse's care for a client who, upon awakening, was disoriented to person, place, and time. The client reports chills and chest pain that is worse upon inspiration. Which of the following actions is the nursing priority? What do we think? Everybody agree? Why wouldn't you do B? What do you think? You want the F part first. You don't have nothing. That's right. Alright, last one for this exemplar. A nurse is caring for a client who has pneumonia. Assessment findings include temperature of 100, respirations of 30, blood pressure 130 over 76, heart rate is 100. O2 sat is 91% on room air. Prioritize the following nursing interventions. Which one was in order? E, C, and D. I heard somebody say A and D. That is correct. It was B, C, A, and D. It's prioritized. I couldn't move it on my PowerPoint like this. Any questions I'm concerned? We are going to take a break before I begin the next exemplar. So I need y'all back in here by 9.15. Don't get lost. So it can occur at any age. It typically occurs between the ages of 10 and 30. It's slightly higher among males due to the genetic makeup. What age did you say again? Between 10 and 30 years old. So I'm going to take an educated guess. I haven't exactly looked up the piece. I have to think about hard mass of stool. The parent is not hydrating the child enough. The kid is not hydrated enough. Hard mass of stool. There we go. All right. So some of the causes. Question number one. Okay. So some of the signs and symptoms. Initially vague, clear umbilical or dull visceral pain that is poorly localized. Nausea is approximately 50% of patients with appendicitis. So 50% of people will have some nausea. All right. Who's reading number two? All right. So number three. We have a low-grade fever may be present. Number four. Noper tenderness may be ill at the mercury point when pressure is applied. I gave y'all a nice picture. Rebound tenderness, pain when the pressure is released. So if the penis ruptures, the pain becomes persistent and peritonitis happens. The distension develops as a result of paralytic ileus in a patient's conditions worsens. So nursing interventions, number one. Who's reading? Come on, Dylan. Release pain. All right. Number two. Do not give eczema or laxatives. Why? Because it can lead to perforation. Number three. Prevent fluid volume deficit. Number four. Reduce anxiety. Number five. Prevent or treat surgical site infections. Number six. Ensure optimal nutrition. All right. Number seven. Ensure the order of antibiotic and IV fluids are placed before surgery. This is done to prevent the infection, replace fluid loss, and promote renal function. Always remember, IV fluids are given until the surgery is performed. Because they will usually be in here. Okay? Causes, number two. The penis has a natural lumen that empties inefficiently, therefore prone to obstruction. A hard mass of stool. An infection follows. Nice pictures there. So signs and symptoms, number six. Who's reading? All right. How do you know the level of what ends up in the abdomen, which causes pain in the stomach? Number, the nurse or individual post-surgical places patient in a high-polished position. Because it reduces the tension on the incision, abdominal organ, and reduces pain. I need to repeat that? Yes? Okay. Because it reduces the tension on the incision, abdominal organ, and reduces pain. You got that? Okay. It also promotes thermic expansion, making breathing easier and reduces the tension of the stomach. T-H-E-L-E-C-K-A-S-I-S. You good? All right. Number nine. Educate patient on the use of incision spirometer and encourage to use it at least every two hours while awaiting. One of the things I used to always kind of help a patient remember something is every other commercial. Every other commercial. All right. That's easy for somebody to remember. Do something every other commercial. You don't have to watch it. It's one topic. But every other commercial. Or every other commercial. It is a huge difference. But you're talking about getting somebody to do something. And you and I both know the incision spirometer sits way on the other side of the room. It's never at the bedside. Or if it's even in the room. Okay? Any questions? Test-wise, every two hours. Okay? I can go to the next one? We good? All right. So, 10-sided diagnostic findings. So, based on the complete history and physical examination, lab findings and imaging studies. So, your white bill account will be elevated. But will be higher than $10,000. Your CRP. Those levels are elevated. What is that for? It's which are protein made by the liver. The level of CRP increases when there's inflammation in the body. Okay. So, when the CT scan or ultrasound is done, why? Why do we think so? Come on. It's the diagnosis. Yes. Yes. Also, a pregnancy test is done to rule out a topic pregnancy. Before any radiology studies are done. So, you may have a young lady who thinks you're saying, why did I have a pregnancy test? Why? And that's why. Because you don't want that to happen first. Also, a UA is done to rule out urinary tract infection or urinary calcii. Which is the kidney stones which are hard deposits made of minerals and salts. Questions or concerns? So, signs and symptoms. So, if you have a patient who has been in pain 10 out of 10 and suddenly says, I don't have any pain anymore. What do you think you should do? Why? If y'all ready, y'all are listening to me. One of the two is happening right now. Okay. Alright. So, it says assume there is a rupture and call the provider immediately because now it has become an emergency. The bacteria in the appendix may have released in the peritoneum called the peritonitis. One of the assessment items in peritonitis is rigid, broad-like abdomen. One of the assessment items in peritonitis is rigid, broad-like abdomen. One of the assessment items in peritonitis is rigid, broad-like abdomen. Alright, nursing intervention. Number 10. Who's reading? Come on back here. This one back here. Opioids, for example, morphine is usually given IV initially to relieve pain which is then switched to an oral agent once the patient starts tolerating fluid and sebum. Alright. Any patient who was dehydrated before surgery received IV fluid? Number 12. Give oral fluid when tolerated by the patient. Who's reading number 13? Correct. And number 14. Give fluid as desired and tolerated after ensuring that bowel sounds have returned. Highly important. Before you start saying here, you can eat. We want to make sure the bowel sounds. Anytime a person has surgery, anything, any other type, you need to make sure you've got bowel sounds. Okay? Monitor urine output to ensure the patient is not experiencing post-operative urinary retention. Experiencing post-operative urinary retention. Number 16. Who's reading? Always eat. Okay? Emulation is big. When I first went to nursing school, it wasn't so much of getting the patient out like first day, but it is like within hours. Okay? Any questions? No? I can move on? See, I know I can't see. I have to see my screen and all, right? So you have to tell me. I do like this to see you. It's free. All right. All right, nursing intervention. So patient may be discharged on the day of surgery. So if temperature is within normal limits, no undue discomfort at the surgical site. And the surgery has laparoscopic. Give discharge instructions to patient and family. When I do discharge instructions, I kind of do a teach-back message. I want you to tell me back that you understand it. And then so when I charge, patient verbally, a verbal understanding. Okay? Teach the family to make an appointment to see the surgeon in one to two weeks for suture remover, if any, and to inspect the wound. Number 20, maybe lifting is to be avoided post-operatively. But normal activity is usually resumed in two to four weeks. Number 21, if patient had a gangrenous or perforated appendix. The patient is at increased risk of an infection and peritonitis. Therefore, monitor for a rigid bra-like abdomen, indicated a peritonitis, and report to the physician immediately. Patient is kept in the hospital for several days. Questions at this time? The appendix is a small, finger-shaped complex tissue located at the lower right side of the abdomen. Although it branches off in the first section of the large appendix, the appendix plays no vital role in the elimination of that defective wave. The appendix can become diseased from bacteria that is present in the intestinal tract. When infected, the appendix becomes large and flanked, causing extreme pain and appendicitis. Symptoms include pain and tinnitus near the navel area that moves towards the right lower abdomen. Nausea and vomiting, low-grade fever, and a confrontation with diarrhea often accompany the pain. Appendicitis is one of the most common causes of emergency abdominal surgery. It is more common in males than in females, and the incidence of this condition peaks in the late teens and early twenties. An inflamed appendix is usually surgically removed during an emergency procedure called appendectomy. Delayed and frequent push-on appendix selection results in serious infection. Okay. A teenage boy was suspected of appendicitis. The caregiver asked, why did my son get this? This was the first time I had ever heard of appendicitis. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. I was a teenager. The caregiver asked, why did my son get this? This was found by the nurse most appropriate. Steve, do y'all agree? Why won't we say... Why don't you say something for me? Wait a minute. Okay, adolescent boys are at great risk for appendicitis. Appendicitis cannot be prevented, but certain dietary habits may reduce the risk for developing this condition. Eating foods that contain high fiber content, such as fresh fruits and vegetables, decrease the incidence of appendicitis. Got that? That's tricky. Alright, which condition may occur if the client does not seek medical attention for acute appendicitis within 24 to 36 hours? Luke? D&E? Does everybody agree? What about you? D&E? So, if the treatment is not initiated, tissue necrosis and gangrene result within 24 to 36 hours, leading to perforation, so the rupture. Perforation allows for content to the GI tract to flow to the peritoneal space of the abdomen, resulting in peritonitis. We already stated appendicitis does not cause seizures, gastritis, or constipation. Any questions before we move on? Alright, so a sprain, who's written it? Alright, severity of a sprain is graded according to how badly the ligament has been damaged. I'm going to say that again. The severity of a sprain is graded according to how badly the ligament has been damaged. The severity of a sprain is graded according to how badly the ligament has been damaged. So, a grade 1 sprain is consisted of stretching or slightly tearing in some fibers of the ligament in a mild hematoma-based form. Manifestations include mild pain, edema, and local tenderness. A grade 2 sprain is more severe. It involves partial tearing of the ligament. I'll say it again. A grade 2 sprain is more severe. It involves partial tearing of the ligament. Manifestations include increased pain with motion, edema, tenderness, joint instability, agmosis, and a partial loss of normal joint function. Alright, a grade 3 sprain is a complete tear or rupture of the ligament. It's symptoms include severe pain, edema, tenderness, and abnormal joint function. It's symptoms include severe pain, edema, tenderness, and abnormal joint function. To try to kind of separate them, I would say grade A, so you have localized tenderness, so they both got pain. Grade 2, I would say, okay, there's partial loss of normal joint function. In grade 3, the distinction is, the difference is the abnormal joint motion. Okay? Got that? I can move? Alright. Okay, so some of the causes is switching motion, forcefully hypertension of a joint. I'm probably going to get a good laugh out of y'all. So, in grade 3, the distinction is, the difference is the abnormal joint motion. In grade 3, the distinction is, the difference is hypertension of a joint. In grade 3, the distinction is, the difference is hypertension of a joint. In grade 3, the distinction is, the difference is hypertension of a joint. In grade 3, the distinction is, the difference is hypertension of a joint. In grade 3, the distinction is, the difference is hypertension of a joint. In grade 3, the distinction is, the difference is hypertension of a joint. Okay, so some of the causes is switching motion, forcefully hypertension of a joint. I'm probably going to get a good laugh out of y'all. So, my ankles, they also swell for other reasons, but they would tend to swell up a little bit more if I'm doing a kind of extra activity. Because I've always had an ankle sprain because I play basketball. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. 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And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. And I play basketball with my ankle. So rest. It prevents additional injury and promotes healing. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. During the first 24 to 72 hours after injury, it produces vasoconstriction. So rest. Intermediate application of COPAX. All right, so we're always going to use the anti-inflammatory. Management of pain. Number four is your neuro check. Circulation, motion, and sensation of the affected extremities. Should be monitored every 15 minutes for the first one to two hours. And then every 30 minutes for the next two hours. And then every 30 minutes for the next two hours. And then every 30 minutes for the next two hours. And then every 30 minutes for the next two hours. And then every 30 minutes for the next two hours. And then every 30 minutes for the next two hours. And then every 30 minutes for the next two hours. 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