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HLTENN003 Perform Clinical Assessment And Contribute To Planning Nursing Care

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  • Course Code: HLTENN003
  • University: TAFE Queensland
  • Country: Australia

Question:

What might be the pathophysiological changes brought about by carbon monoxide in his body?

Enlist the seven (7) possible signs and symptoms that the patient may manifest?

The following table gives the common disorders, problems and complaints associated with each body system and its components relevant to the nursing care you might provide for your clients in the Australian health care system. Complete the following table with regard to its definition, pathophysiology, signs and impact of specific health procedures.

What is the impact of a high protein diet on patients with Cirrhosis of the Liver?

Nurses should ensure adequate fluid intake in patients with urinary tract infection. Briefly describe the impact of this nursing intervention.

What is the Impact of Wearing a Splint for a Patient with Carpal Tunnel Syndrome?

 

Answer:

QUESTION 1

  • Pathophysiological Changes due to Carbon Monoxide in Inhalational Burns

Inhaled carbon monoxide combines with hemoglobin to form carboxyhemoglobin which reduces the ability of hemoglobin to release oxygen hence causing cellular hypoxia.

In cardiac system, poisoning due to CO can cause infarction, ischemia and dysrhythmias. Some of the pathophysiological changes in CNS are neurological dysfunctions, acute intoxication and chronic neurological sequelae.

  • Seven Possible Signs and Symptoms in Carbon Monoxide poisoning: Headache, Nausea/vomiting, Loss of consciousness, Confusion, Dyspnea and Myocardial infarction

QUESTION 2

 

2.1 Definition of Cerebrovascular Accident/Stroke

It is a medical condition associated with insufficient blood flow to different areas of the brain.

2.2 Pathophysiology of Cerebrovascular Accident: Involves disruption of blood flow to the brain due to complete or partial occlusion of cerebral vessels by embolism, thrombosis or hemorrhage.

  • Signs of Cerebrovascular Accident: Face drooping/loss or change in vision, Speech difficulties, Weakness and Numbness

2.4 Impact of Head-up position in a patient with stroke: improves the flow of blood to the brain to minimize neurological deficits hence promoting recovery.

QUESTION 3

3.1 Epilepsy: It is a neurological disorder whereby brain functioning is abnormal leading to seizures, sensations, unusual behavioral patterns and loss of awareness.

3.2 Pathophysiology of Epilepsy: It results from excessive firing of neurons which excessively excite a large number of neurons hence generating a huge electrical impulse leading to seizures.

  • Signs of Epilepsy: Unconsciousness, confusion, legs and arms jerking movements and anxiety

3.4 Sided Rails for patient with seizures: They act as a primary precaution to restraint and the patient for hurting himself or herself.

QUESTION 4

4.1 Raynaud’s Phenomenon: It is a disorder associated with abnormality of blood vessels due to smooth muscle over activity leading to vasospasms of the vessels supplying blood to the hands, legs, arms and feet.

4.2 Pathophysiology of Raynaud’s phenomenon: Body parts such as legs, fingers experience intensive vasospasms which are associated with hyperemia and changes in skin color. It involves vasoconstriction, cyanosis and rapid reflow of blood.

  • Signs of Raynuad’s Phenomenon: Blanching of fingers, Triphasic reaction and Skin blanching
  • 4 Impact of calcium channel blockers in patients with Raynaud's phenomenon:They cause vasodilation of arteriolar and increase the peripheral flow of blood.

QUESTION 5

5.1 Asthma: It is a chronic airway disease that compromises breathing due to narrowing of the airways.

5.2 Pathophysiology of Asthma: The underlying mechanisms include inflammation of the airways due to environmental allergens, bronchoconstriction and tightening of the smooth muscles of the respiratory passage.

5.3 Signs of Asthma:  Coughing, wheezing, breathing difficulties and chest tightness

5.4 Impact of inhaled Corticosteroids in Asthma: They act by suppressing the airway inflammation hence reducing the level of hyper responsiveness of the airway which consequently relives other symptoms of asthma.

QUESTION 6

6.1 Pneumonia: It is an inflammatory lung condition which primarily affects the alveoli.

6.2 Pathophysiology of pneumonia: It can be viral or bacterial. It is commonly caused by Streptococcus Pneumoniae. These organisms cause the air sac to develop pus or fluid leading to a cough with pus or phlegm, chills, fever and difficulties in breathing.

6.3 Signs of Pneumonia: Cough with phlegm, sweating, shortness of breath and fatigue.

6.4. Hydration in Pneumonia: facilitates expectoration of secretions by the patient.

QUESTION 7

7.1 Peptic Ulcer: Refers to an open sore on the inner lining of the stomach and its located on the upper part of the small intestines.

7.2 Pathophysiology of peptic ulcer: Mucosal injury due to disruption in protective and aggressive factors. Protective factors include epithelial renewal, bicarbonate, sufficient mucosal blood flow and prostaglandins while aggressive factors are infection due to Pylori, alcohol consumption, NSAIDS, pepsin and bile salts.

7.3 Signs of peptic ulcer: Abdominal pain between the bottom of the belly and breastbone, increased level of indigestion, nausea and heavy abdomen.

7.4 Impact of antibiotic therapy on patients with peptic ulcer disease: Kills the H.Pylori bacteria, suppresses production of acid and neutralize any acid in the stomach.

QUESTION 8

8.1 Cirrhosis of liver: It is a liver disease complication involving liver cell loss and irreversible liver scarring.

8.2 Pathophysiology of cirrhosis of liver: It involves hepatocyte destruction, scarring or fibrosis leading to obstruction of the flow of blood, high pressure in sinusoidal and venous channels.

8.3 Signs of Cirrohsis of the liver: Anorexia, Yellow skin discoloration, easy bleeding and leg swelling.

8.4 impact of a high protein diet on patients with Cirrhosis of the Liver: Improves and supports liver functioning hence promoting healing.

 

QUESTION 9

9.1 GOUT: An inflammatory arthritis associated with recurring attacks of hot, red, swollen joints.

9.2 Pathophysiology:  Results from high levels of uric acid in blood which crystallizes and gets deposited in tendons, joints and adjacent tissues.

9.3 Signs: Joint stiffness, joint tenderness, joint pain and red look at the joint.

9.4 Allopurinol on patients with gout: Regulates the production of uric acid hence reducing its amount in blood.

9.4 Impact of Wearing a Splint for a Patient with Carpal Tunnel Syndrome: Relieves the amount of stress or pressure applied at the joint.

QUESTION 10

10.1 Carpal Tunnel Syndrome: A condition associated with pain, tingling and numbness in the arm or hand.

10.2 Pathophysiology: Results from medial nerve compression at the carpal tunnel in the wrist.

10.3 Signs: numbness, weakness, tingling and pain.

10.4 Impact of Wearing a Splint for a Patient with Carpal Tunnel Syndrome: Relieves the amount of stress or pressure applied at the joint.

QUESTION 11

11.1 Nephrotic Syndrome: It is a disorder of the kidney that is characterized by edema, hypoalbuminemia and proteinuria.

11.2 Pathophysiology:  It involves hypoalbuminemia due to loss of protein in urine, edema and proteinuria

11.3 Signs: Anorexia, fatigue, weight gain and foamy urine.

11.4 Restriction of Salt intake in nephrotic syndrome: It helps to avoid fluid and electrolyte imbalances which could severely damage the kidneys.

QUESTION 12

12.1 Urinary Tract Infection (UTI): An infection the kidneys, bladder, ureters or urethra of the urinary system.

12.2 Pathophysiology: They are caused by microorganisms such as bacterial, viruses and fungi in the upper and lower urinary tract.

12.3 Signs: Pain, tenderness, bloody urine, burning sensation during urination

12.4 Fluid intake in UTI: Promotes kidney functioning and prevents formation of concentrated urine which might cause irritation of the urinary bladder leading to a high risks of UTI development.

QUESTION 13

13.1 Prostatic Cancer: Non-cutaneous Cancer of the prostate gland in men.

13.2 Pathophysiology: Uncontrollable and excessive growth of prostate cells leading to a malignancy at the prostate gland.

13.3 Signs: hematuria, painful and difficult urination, reduced bladder control and reduced urine velocity

13.4 Impact of 5 alpha reductase inhibitors on patients with prostatic cancer:  They prevent conversion of sex hormone testosterone to dihydrotestosterone (DHT) which is more potent androgen. They prevent this conversion by blocking the action of 5 alpha reductase which facilitates conversion of testosterone hormone to DHT hence decreasing DHT levels and increasing testosterone levels.

QUESTION 14

14.1 Diabetes Mellitus: A metabolic disorder characterized by elevated sugar levels in blood for a long period of time.

14.2 Pathophysiology: It is associated with insufficient or impaired production of insulin, increased production of glucose, genetics, lifestyle, increased insulin resistance in the body.

14.3 Signs: Increased frequency of urination, unexplained loss of weight, increased thirst and sudden changes in vision.

14.4 Impact of insulin therapy on patients with diabetes: Regulates the amount of sugar by concerting the excess glucose to glycogen for storage in the body.

QUESTION 15

15.1 Hypothyroidism: A medical condition associated with insufficient thyroid hormone in the body.

15.2 Pathophysiology: Involves Hashmoto disease, hereditary problems of thryroxine and triiodothyronine, tumors of the pituitary gland and drugs.

15.3 Signs: Poor concentration, fatigue, weight gain with anorexia and changes in hearing ability.

15.4: Low calorie diet: Promotes weight loss due to the excessive weight gained in hypothyroidism.

QUESTION 16

16.1 Systemic lupus erythematosus (SLE): An autoimmune disorder in which the immune system attacks other tissues in various body parts.

16.2 Pathophysiology: Involves production of antibodies to fight other body tissues leading to inflammation

16.3 Signs: Swollen joints, loss of hair, ulcers in the mouth and rashes

16.4 Impact of hydroxychloroquine on patients with SLE: Prevents damage of organs in a patient with SLE

 

QUESTION 17

17.1 Hodgkin's disease: Lymphatic system cancer, a part of the immune system.

17.2 Pathophysiology:  Involves development of a genetic mutation from a lymphocyte. The mutation stimulates rapid multiplication of cells.

17.3 Signs: Sweating at night, drastic loss of weight, severe itching and swelling of lymph nodes at the armpits, neck and groin.

17.4 Impact of chemotherapy on patients with hodgkin's lymphoma: Destroys cancerous cells in different body parts.

QUESTION 18

18.1 Méniere's disease: Inner ear disorder characterized by vertigo, hearing loss, tinnitus and ear fullness.

18.2 Pathophysiology: Involves environmental factors, genetic factors, viral infections, blood vessel constriction and autoimmune reactions and abnormal amount of endolymph.

18.3 Signs: Hearing loss, vertigo, tinnitus and fullness in the ear.

18.4 Impact of antihistamines on patients with Méniere's disease: Treats tinnitus, vertigo and hearing loss.

QUESTION 19

19.1 Senile Cataract: An age-related disease associated with progressive and slow thickening of eye lens hence impairing vision.

19.2 Pathophysiology: Thickening of the eye lens with age leads to impairment of vision.

19.3 Signs:  blurred/clouded vision, yellowing or fading of colors, diplopia in one of the eyes and sensitivity to glare and light.

19.4 Avoiding lifting of heavy object after cataract surgery: Prevents further injuries hence promoting faster healing.

QEUSTION 20

20.1 Tool used for assessing his level of consciousness: Glasgow Coma Scale

QUESTION 21

21.1 Eye opening-2(opens eye in response to pain), Motor response -3(decorticate), Verbal Response-1(no verbal response)

21.2 I would closely monitor the patient on hourly basis and inform the medical officer who is on duty to attend the patient. I would provide analgesics according the scale of pain. I would maintain the airway patent by elevating his or her head at 30 degrees, suctioning and positioning in a lateral position.

QUESTION 22

22.1 Dyspnea or wheezing- Contraindication-Chest physiotherapy

Nursing implication-put the patient on oxygen

22.2 Bleeding-Contraindication-Avoid intramuscular injections in a patient with a bleeding disorder. Nursing Implication-Stop bleeding and administer fluids.

22.3 Hypotension-Contraindication-Avoid strenuous physical exercises

Nursing implication-Give vasopressor and IV fluids.

22.4 Allergy to seafood-Contraindication-Avoid sea foods

Nursing implication-provide alternative foods

22.5 Past history of mastectomy-Contraindication-Inoperable and locally located cancer of the breast. Nursing implication-Patient education on other management options

22.6 Neutropenia-Contraindication-Surgical interventions. Nursing Implication-Provide supportive health care.

QUESTION 23

23.1 Filling respective forms, taking vitals of the patient, giving a patient attention to obtain history. The nurse also initiates treatment and provide first aid care in case the patient cannot wait for the whole process of admission, priority nursing.

23.2 Patient full names, identification number, sex, age, marital status, date of birth, place, of birth, place of residence, findings on assessment of the patient, time and date of admission.

23.3 Doctor- Assessing patients, making diagnosis, treating clients, making medical prescriptions and some conduct surgeries.

23.4 Pharmacist-dispensing drugs, educating clients on use of different medications prescribed, advising nurses and physicians on medications given to patients. They ensure that drugs remain strong and pure by properly storing them.

23.5 Discharge planning-Include the relatives of the patient, discuss the measures of preventing further complication with the patient and his family, educate him and his family about the outcome of the patient’s condition. Assess how nurses and doctors explain the condition and diagnosis to the patient and his family. Listen carefully to honor the concerns, preferences, goals and observations of the relatives.

23.6 Discharge details-date of discharge, discharge summary, condition of the patient on discharge, prescribed medications if any, diagnosis, person who discharge the patient and his or her signature.

QUESTION 24

24.1 Physiological development-Reflex movements such as startling and sucking. Jerking and uncontrolled movements of arm and legs.

24.2 Cognitive development-The infant learns things like sound, feel, smell and site. The infant starts to repeat movements. At 3 months, the child is able to recognize familiar persons from far. At 5 months, he recognizes his own name when mentioned. At 7 months, practices combining sounds and talking to mothers or caregivers.

24.3 Motor Development- Reflex movements such as startling and sucking. Jerking and uncontrolled movements of arm and legs.  At 3 months, holds his head unsupported and props up on his arms. At 5 months, the child grabs objects and starts rocking on tummy.  At 9 months, he starts sitting down, crawling, copies gestures and points at objects. At 12 months, the child is fully developed.

QUESTION 25- TODDLER (1-3 YEARS)

25.1 Physiologic development- Rapid increase in their Coordination and skills whereby the toddler learns on kicking a ball, climbing stairs and grasping a pen or pencil for scribbling.

25.2 Psychosocial development-In the first one and half years, the child may develop trust or mistrust towards caregivers and other people. They later develop a sense of autonomy which turns to doubt and shame when they are discouraged. 

25.3 Cognitive development. Counts up to 3 and can tell his or her age by counting fingers, conforms to words spoken by other people. Use of language when resisting.

25.4 Motor development-Has fine motor skills with stiff and shaky movements, holding on crayons with full fist and cannot draw circles or straight lines by himself.

QUESTION 26 –PRE-SCHOOLER (3-5 YEARS)

26.1 Physiological development-Fully applies body parts such as hands, legs without support. Can climb trees, kick a ball, stand, run and walk on tiptoes. Physiological development is complete.

26.2 Psychosocial development-can adhere to simple instructions and rules such as games and may approach new people alone without fear.

26.3 Cognitive development-Can engage in conversations, knows his or her age and name, can name days of the week, differentiate between a heavy and a light object. Can narrate a story from the begging to the end and can differentiate between fantasy and reality.

26.4 Motor development-use of their small muscles like hands or fingers. Ability to hold crayons firmly, draw triangles, circles and squares. Ability to unzip or button his or her clothes.

QUESTION 27 Schooler (5-12 years)

27.1 Physiologic development-Stays busy with activities such as playing, likes drawing and painting, loses the first tooth, has a sharp vision, rides bicycles and plays rope jumping.

27.2 Psychosocial development-Develops jealousy for siblings and others, shares and cooperates with others, plays with friends of his gender and likes copying adults.

27.3 Cognitive development-Clearly understands the number concept, differentiates between day and night, left a d right hands, tells time and can draws complex shapes like diamond.

27.4 Motor Development-He becomes graceful with abilities and movements. He chases, jumps and skips. Completely and smartly dresses himself. He can handle some tools like screwdrivers and hammers.

 

QUESTION 28

Play has both psychological and physiological benefits in the development of a child. Play stimulates the imagination of a child, enhances learning, promote development of social a d communication skills. Additionally, play improves child’s creativity, promotes increment in abilities to solve problems and helps the child to adjust to a particular environmental settings

QUESTION 29

Purpose of assessment, reliability, validity, acceptability, fairness, feasibility

QUESTION 30

 

Developmental stage

Reaction to Hospitalisation

30.1 Infant (birth to 18 months) –unable to express verbal communication, irritability, separation distress, decreased morale for playing, crying a lot, lethargy and tactile hypersensitivity.

30.2 Toddler (18 months to 3 years) –Views the hospital as a punishment, reduced appetite, increased cries, irritability, refuses to eat, decreased playing and verbal communication of pain.

30.3 Pre-schooler (3-5 years) –Regression, may perceive the hospital as a punishment, nightmares, treatment misconceptions, verbalizes pain and aggression.

30.4 Schooler (6-12 years)-Aggression, regression, withdrawal and denial from their favorites and they may virtualize pain.

QUESTION 31 EFFECTS OF INFERTILITY

31.1 Emotional effects-For women, being a mother is a very important aspects which contribute to one’s image. One feels frustrated and disappointed by the fact that he or she is not able to have children. It is also associated with anger and sorrow.

31.2 Control over life –infertility lowers one’s level of self-esteem and confidence hence compromising life control abilities.

31.3 Social effects-Due to the feelings of depression, sorrow, frustration and anger, one tends to withdraw from friends and family. He or she feels unaccepted by the society.

31.4 Self-esteem- Infertility in an individual involves typical reactions such as anger, depression, grief, shock. Frustration and loss of confidence. These reactions lowers one’s level of self-esteem making him or her feel worthless.

31.5 Relationship- Relationships suffer not only primary ones with a partner but also with family members and friends who inadvertently lead to pain by proving misguiding advice and opinions. A couple may avoid socialization especially with fertile friends and they struggle with the anxiety due to sexual dysfunctions.

 QUESTION 32 FAMILY HEALTH CARE NEEDS

Some families may be having children who require specialized health care. Therefore, they will need the health care professional for guidance.

A couple with infertility issues may need guidance from health care professionals on how to deal with such a problem and be have a happy life at the same time.

Families have genetically inherited disorders such as asthma, hypertension or sickle cell disease. They need help from health care professionals for more advice and information on such problems.

QUESTION 33

33.1 Influence of genetics on human development-Genes are responsible for the characteristics and traits of an individual. Chromosomes also play an important role in gene formation. Deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) work together to ensure genetic transmission. DNA dictates the physical characteristics such as baldness and eye color. Molecules of DNA are always found in the fertilized ovum. Therefore, genetics influences human development since the traits are transferred to the other generations of that lineage.

33.2 Influence of environment on human development-Some factors such as age the age of the mother can lead to congenital abnormalities of the fetus hence influencing its development. Nutritional deficiencies among mothers can lead to still births or neonatal morbidity and mortality. Emotional stress from the environment can lead to premature births and miscarriages. Other environmental factors such as microorganisms, radiations, chemicals or drugs can adversely lead to birth defects or impair development.

QUESTION 34

34.1 Growth- Quantitative and irreversible increase in size and height of an individual.

34.2 Development-Qualitative and irreversible growth of other body components for specialization to different functions in the body.

34.3 Principles of Growth and Development-Development is sequential, development is gradual, growth and development are products of environment and heredity, development is predictable, development is continuous and most of the traits are correlated in the process of development.

QUESTION 35  

35.1 A client has right sided hemiplegia: Use loose-fitting dressings and silky fabrics. Use the arm that is not affected. Can sit on a wheel chair.

35.2 A client has difficulty feeding himself due to chronic osteoarthritis in wrist and knuckles –Assist the patient to feed

35.3 Client has Parkinson's disease moderately affecting his mobility. Client needs to get up from his bed and stand –Physiotherapy to strengthen his body muscles and improve mobility.

35.4 Client is old and had a recent fall. He finds it hard to walk by himself –assist the patient to walk r provide a wheel chair where he can move himself or herself. Forearm crutch can also help the patient walk with support.

QUESTION 36-

Community services and resources-family health clinics, dispensaries, mobile clinics, community health centers

QUESTION 37

37.1 –Professional supervision, service delivery approaches, working alliance, values, philosophies and beliefs.

37.2- Nutrition for health and well-being, enteral nutrition and managing dysphagia.

QUESTION 38

38.1 Factors contributing to Physiological wellness-food, lifestyle and spirituality.

38.2 Factors contributing to psychosocial wellness-Family, hereditary traits and emotional and mental health.

QUESTION 39 Health Assessment Techniques

Inspection-visual examination by observing and using other senses of hearing and smell.
 Palpation-involves touching the client using different parts of the hand applying varied pressure.
 Percussion-Involves tapping your hands or fingers sharply and quickly against the body of the client in order to locate borders of organs, position, shapes and tenderness.
Auscultation-use of a stethoscope to listen for heart, bowel and lung sounds.

QUESTION 40

The reading might be wrong. I can verify by checking the oxygen saturation four times every day for five consecutive days using a pulse oximeter since the saturation keeps on fluctuating based on one’s daily activities.

QUESTION 41 -

Strategies for using a problem solving approach to any solution-problem identification, exploration of previous attempts to solve the problem, exploration of alternatives, solution selection, implementation of the selected selection and outcome evaluation.

QUESTION 42

42.1 Early adult period (20 to 40 years)-Major activities-establishment of economic and personal independence, identity exploration especially in work and love. Variation of health needs: Most of the health needs are at peak without much variations requiring health attention.
42.2 Middle adulthood (40 to 65 years)-Major activities-balancing relationship and work, assessing the priorities of life, expansion of responsibility and social and personal involvement
Variation of Health needs:  joint stiffness, difficulties in movement, weight loss, chronic health issues such as heart disease, diabetes and hypertension, declined vision, gradual decline in hearing ability.
42.3 Older adult (older than 65 years of age)-Major activities-retirement adjustment, review of socialization patterns and adoption of new social roles. Variation in Health Needs-eye disorders such as glaucoma and cataracts and other health issues such as osteoporosis, arthritis and other psychological disorders which required health are attention.

QUESTION 43

43.1 Men-cardiomyopathies

43.2 Women-depression and osteoporosis

QUESTION 44

44.1 methods used to measure or evaluate vision and hearing-Vision: Amsler Grid test, slit-lamp test, confrontation test, keratometer, ophthalmoscope, perimetry testing, refraction test, tonometry, tangent scree test, visual acuity test and visual field test. Hearing:

44.2 2 aids and equipment used for assisting clients with vision and/ or hearing impairment. Vision –glasses and sheets. Hearing: hearing loop and telecoil.

QUESTION 45

45.1 Angina Pectoris: Chest discomfort of pain due to coronary heart disease.

45.2 Pathophysiology: Involves myocardial ischemia which result from imbalanced myocardial oxygen demand and blood supply.

45.3 signs: anxiety, profuse sweating, fatigue and breathing difficulties.

45.4 Impact of supplemental oxygen therapy in patients with angina: Angina is mainly due to insufficient oxygen supply therefore oxygen therapy supplements the required body oxygen hence promoting healing.

QUESTION 46

46.1 Chest pain/heart attack

46.2 Migraine headache

46.3 Asthma

46.4 Cerebrovascular Accident (stroke)

46.5 Pulmonary Hypertension

QUESTION 47

48.1 Developmental stages of "Adolescence" with age group

  • Early adolescence(11-13) years
  • Middle adolescence (14-18) years
  • Late Adolescence (19-21) years

48.2 Common health issues for adolescents-physical changes, emotional changes, behavioral variations and substance abuse and use.

 

References

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.

LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-surgical nursing. Pearson Higher Education AU.

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Great work from expert! All good just missing one 1 reference, feedback and get it within a few hours.

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User Id: 254651 - 10 Jul 2020

Australia

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Amazing work, thank you very much I have achieved amazing results. Thank you for your hard work

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User Id: 261191 - 10 Jul 2020

Australia

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Really good work on the code. It ran perfectly and there were no mistakes in the code. All of the instructions were followed and there were no syntax errors at all.

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User Id: 457776 - 10 Jul 2020

Australia

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very clear answers, full of information. The doctor was very happy with the answers. Thank you.

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User Id: 391476 - 10 Jul 2020

Australia

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