P K DAS COLLEGE OF NURSING

LESSON PLAN
ON
PNEUMONIA
Submitted To Submitted By
PROF.DR ARYALAKSHMI RAVEENA.R. NAIR
HOD. Child Health Nursing First Year MSc NURSING
P.K.Das CON Nursing Education

Submitted On: 03 / 01 /2025

BACKGROUND OF INFORMATION

1
Name of the Student Teacher RAVEENA R NAIR
Topic PNEUMONIA
Subject NURSING EDUCATION
Duration 1 HOUR
Date & Time
Methods of Teaching LECTURE CUM DISCUSSION
AV-Aids PPT, Pamphlets, Chart, Handouts

General Objectives
At the end of the lecture students will gain knowledge about Pneumonia and develop a positive attitude towards it and will be able to apply this
knowledge in clinical setting.

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Specific Objectives
At the end of the lecture the students will be able to :-
 Define Pneumonia
 List down the Causes of Pneumonia
 Memorize the Types of Pneumonia
 Explain the Pathophysiology of Pneumonia
 Relate the Clinical Manifestations of Pneumonia
 Tell the Diagnostic Evaluations of Pneumonia
 Practice Medical, Surgical Management & Nursing Management of Pneumonia

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Sr. Specific AV- Teaching Learning Evaluation
No Time Objectives Content Aid Methods Activity
s
1. 1Mnt. At the end of INTRODUCTION: PPT Lecture Listen What is
the lecture the Pneumonia is a lung infection that causes inflammation of the air cum Pneumonia?
student’s will sacs (alveoli) in one or both lungs, which can fill with fluid or pus. discussion.
be able to: This condition can lead to symptoms such as cough, fever, chills,
shortness of breath, chest pain, and fatigue. Pneumonia can vary in
severity, ranging from mild to life-threatening, and it can affect
people of all ages, although it is most dangerous for infants, young
children, elderly adults, and those with weakened immune systems or
chronic health conditions.
Pneumonia can be caused by several different pathogens, including
bacteria, viruses, fungi, or parasites. The most common causes of
bacterial pneumonia are Streptococcus pneumoniae, Haemophilus
influenzae, and Staphylococcus aureus, while viral pneumonia can
result from influenza, respiratory syncytial virus (RSV), or
coronaviruses, among others.

2. 1min. Define the DEFINITION

Pneumonia Pneumonia is an infectious process resulting from the invasion and PPT Lecture Listen Define
overgrowth of microorganisms in lung parenchyma and breaking cum Carefully Pneumonia?
down defences and provoking intra-alveolar exudates. _Sukhpal Kaur discussion

Pneumonia is an inflammation of the lung parenchyma caused by

microbial organism. _ Lewis’s

List down the

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3. 2min. causes and CAUSES: H Ask Learners What are the
risk factors of Pneumonia can be due to a variety of bacteria and viruses, less Question answer the causes and risk
Pneumonia commonly due to fungi and rarely due to other microorganisms or A questions factors of
parasites. Likely causes are associated with the age of the person, the Pneumonia?
season, the person's health status, and/or where the infection was N
contracted.
D
 Aging
 Air pollution O
 Altered consciousness: alcoholism, head injury, seizures, Student
anaesthesia, drug overdose, stroke U Teacher
 Altered oropharyngeal flora secondary to antibiotics Appreciate
 Bed rest and prolonged immobility T the students.
 Chronic diseases: chronic lung disease, diabetes mellitus,
heart disease, cancer, end-stage renal disease S
 Debilitating illness
 Human immunodeficiency virus (HIV) infection.
 Immunosuppressive drugs (corticosteroids, cancer
chemotherapy, immunosuppressive therapy after organ
transplant)
 Inhalation or aspiration of noxious substances
 Intestinal and gastric feedings via nasogastric or nasointestinal
tubes,
 Malnutrition
 Smoking
 Tracheal intubation (endotracheal intubation, tracheostomy)
 Upper respiratory tract infection

Acquisition of organisms. Organisms that cause pneumonia reach

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 the lung by three methods:

1.Aspiration from the nasopharynx or oropharynx. Many of the

organisms that cause pneumonia are normal inhabitants of the
pharynx in healthy adults.
2. Inhalation of microbes present in the air. Examples include
Mycoplasma pneumoniae and fungal pneumonias,

3. Hematogenous spread from a primary infection elsewhere in the

body. An example is Staphylococcus aureus.

Memorize the TYPES OF PNEUMONIA:

4. 3min. types of F Explain the Take notes Enlist the types
Pneumonia Pneumonia can be classified according to the causative organism; a Types of of Pneumonia?
clinically effective way is to classify pneumonia as community- L peptic ulcer
acquired or hospital-acquired pneumonia. Classifying pneumonia is
important because of difference in the likely causative organisms and A
the selection of appropriate antibiotics.
S

H
Hospital-acquired,
Community-acquired ventilator-associated,
pneumonia and health care-
Fungal Pneumonia C
associated pneumonia.
A

Opportunistic
R
Aspiration pneumonia
pneumonia
D

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 .
1.Community-acquired pneumonia.

Community-acquired Pneumonia (CAP) is defined as a lower

respiratory tract infection of the lung parenchyma with onset in the
community or during the first 2 days of hospitalization.

Organisms Associated with Pneumonia

 Streptococcus pneumoniae
 Respiratory viruses
 Chlamydia pneumoniae
 Oral anaerobes
 Staphylococcus aureus
 Enteric aerobic gram-negative bacteria (e.g., Klebsiella)
 Fungi
 Mycobacterium tuberculosis
 Staphylococcus aureus
 Streptococcus pneumoniae
 Oral anaerobes

2.Hospital-acquired, ventilator-associated, and health care-

associated pneumonia.

Hospital-acquired pneumonia (HAP) is pneumonia occurring 48

hours or longer after hospital admission and not incubating at the
time of hospitalization.

Ventilator-associated pneumonia (VAP) refers to pneumonia that

occurs more than 48 to 72 hours after endotracheal intubation.

Health care-associated pneumonia (HCAP) includes any patient with

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a new onset pneumonia who:

(1) was hospitalized in an acute care hospital for 2 or more days

within 90 days of the infection;

(2) resided in a long-term care facility;

(3) received recent intravenous antibiotic therapy, chemotherapy, or

wound care within the past 30 days of the current infection; or

(4) attended a hospital or haemodialysis clinic.

3.Fungal Pneumonia

Caused by fungi that can infect the lungs, particularly in

immunocompromised individuals.

Types of fungal infections include:

Histoplasmosis (caused by Histoplasma capsulatum)

Coccidioidomycosis (caused by Coccidioides species)
Aspergillosis (caused by Aspergillus species)

Symptoms can range from mild to severe and may include cough,
fever, chest pain, and difficulty breathing.

4.Aspiration pneumonia

Aspiration pneumonia refers to the sequelae occurring from

abnormal entry of secretions or substances into the lower airway. It
usually follows aspiration of material from the mouth or stomach into

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 the trachea and subsequently the lungs. The person who has
aspiration pneumonia usually has a history of loss of consciousness
(e.g., as a result of seizure, anesthesia, head injury, stroke, or alcohol
intake). With loss of consciousness, the gag and cough reflexes are
depressed, and aspiration is more likely to occur. Another risk factor
is tube feedings. The dependent portions of the lung are most often
affected, primarily the superior segments of the lower lobes and the
posterior segments of the upper lobes, which are dependent in the
supine position.

The aspirated material-food, water, vomitus, or toxic fluids-is the

triggering mechanism for the pathology of this type of pneumonia

5.Opportunistic pneumonia. Certain patients with altered immune

responses are highly susceptible to respiratory infections. Individuals
considered at risk include:

(1) those who have severe protein-calorie malnutrition;

(2) those who have immune deficiencies;

(3) those who have received transplants and been treated with
immunosuppressive drugs; and

(4) patients who are being treated with radiation therapy,

chemotherapy drugs, and corticosteroids (especially for a prolonged
period

Explain the

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5. 1min. pathophysiolo C Lecture Listen Explain about
gy of cum carefully Pathophysiolo
Pneumonia H discussion gy Of
PATHOPHYSIOLOGY Pneumonia?
A
Aspiration of gastric content or bacteria enter the lung
R

Inflammatory response

Cavity extend to bronchus

Relate the
6. 2min. clinical Abscess become encapsulated P Lecture Focus What are the
manifestations cum Attention clinical
of Pneumonia Tissues Necrotize A discussion manifestations
of Pneumonia?
M

H
Increase production of sputum
L
Purulent Sputum

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 CLINICAL MANIFESTATIONS: E

Productive Cough T
Pleuritic Chest pain
Headache S
Fever
Shortness of breath
Tell the Tachypnoea
7. 2min. Diagnostic Hypoxia PPT Lecture Logical Tell the
Evaluation of Increased work breathing cum thinking diagnostic
Pneumonia Vomiting /Nausea discussion evaluations of
Increased Vocal Fremitus Pneumonia?
Dullness to Percussion
Bronchial Breath Sounds

DIAGNOSTIC EVALUATION

HISTORY: A careful history regarding the presence of risk factors

such as comorbid conditions, use of immunosuppressive drugs,
malnutrition, anemia, COPD/smoking, previous hospitalizations, and
travel history should be obtained. A detailed history regarding the
onset of symptoms such as fever, cough, presence of sputum,
shortness of breath, dyspnea, headache, myalgia, arthralgia, nausea,
vomiting, and diarrhea.
PHYSICAL ASSESSMENT: A patient's level of consciousness should be
checked to rule out possibility of micro aspiration. A general physical
examination to reveal presence of tachypnoea, tachycardia, pleuritic

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 chest pain, crackles, rales, bronchial breath sounds and increased
fremitus should be performed.

MICROBIOLOGICAL INVESTIGATIONS: Sputum and other respiratory

samples from the lower respiratory tract through endotracheal
aspirates, bronchoalveolar lavage or specimen brush can be obtained
to identify the etiological agent and to determine the basis for empiric
antimicrobial therapy. Gram staining of sputum samples is done to
determine gram- positive and gram-negative bacteria.

CHEST RADIOGRAPHY: A chest X-ray may show presence of

pulmonary infiltrates. They are also done to determine whether the
pneumonia involve one or both the lungs or lobar or interstitial
pneumonia. A CT can be done in the absence of positive chest X-ray
and presence of clinical symptoms but is usually avoided.

BLOOD TESTS: Routine blood biochemistry and CBC can be done to

Practice the determine neutrophils count, total and differential leukocyte count,
8. 5min. Management erythrocyte sedimentation rate (ESR) and C-reactive protein. Blood PPT Lecture Listen Explain the
of Pneumonia culture can be done to determine etiological agent. cum carefully & management of
discussion take notes Pneumonia?
Pulse oximetry/ABG: The oxygen saturation level in the blood can be
assessed through continuous monitoring at the bedside. ABG analysis
can be carried out to determine presence of respiratory acidosis.

The diagnostic criteria for pneumonia are the presence of chest

infiltrate on chest radiograph along with at least two of three clinical
signs (fever >38°C, leukocytosis or leukopenia or purulent
secretions).

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MEDICAL MANAGEMENT

MEDICAL MANAGEMENT

The management of pneumonia depends on its severity. CURB-65

score is calculated to classify patients suffering from pneumonia
based on their severity.

CURB-65 represents: C = confusion; U = Uremia [blood urea

nitrogen (BUN) >20 mg/dL]; R = respiratory rate (RR) >30
breaths/minute; B = Blood pressure (SBP <90 mm Hg and DBP <60
mm Hg); Age = >65 years. CURB-65 score >2 requires
hospitalization.

ANTIMICROBIAL THERAPY: Various classes of antibiotics are

used to treat mild-to-severe pneumonia. These can be grouped based
on their mechanism of action:

❖ Inhibitors of nucleic acid synthesis (e.g., fluoroquinolones);

◆ Inhibitors of protein synthesis (e.g., aminoglycosides, macrolides,

tetracyclines, ketolides, and oxazolidinones); and

◆ Inhibitors of peptidoglycan synthesis (e.g., ẞ-lactams and

glycopeptides); and agents interfering with membrane function (e.g.,
cationic peptides and lipopeptides). Various organizations have given
their guidelines for the management of pneumonia based on its
severity score. Following are the British Thoracic Society (BTS)
guidelines.

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 Pharmacotherapy Other Treatment

Low Severity Oral amoxicillin 500 Avoidance of

mg three times a day smoking
CURB65 score = 0- or doxycycline;
1 patient Provide adequate
hypersensitive to rest
amoxicillin, treat
with clarithromycin Provide plenty of
fluids (1-2
liters/day)

Report chest pain,

increased shortness
of breath, and
lethargy.

If not recovered
within 48 hours,
hospitalization is
required.

Moderate Severity Oral amoxicillin Monitor

plus clarithromycin; temperature, pulse,
CURB-65 score = 2 If oral therapy respiration, blood
contraindicated, pressure, mental
Inpatient Treatment intravenous (IV) status, SpO₂,
amoxicillin or inspired oxygen
benzylpenicillin plus concentration
clarithromycin;

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 patients allergic to frequently.
penicillin, can be
given oral • Provide oxygen
doxycycline, therapy as
moxifloxacin or recommended.
levofloxacin or IV
levofloxacin, second • Administer
generation intravenous fluids.
(cefuroxime) or
third generation • Provide nutritional
(cefotaxime, or support.
ceftriaxone)
cephalosporin plus • Perform repeated
clarithromycin chest X-rays to
monitor progress

High Severity Combination of • Monitor

broad spectrum ẞ- temperature, pulse,
CURB-65 lactamase antibiotic respiration, blood
(co-amoxiclav) pressure, mental
Score= 3to5 status, SpO₂,
Macrolide inspired oxygen
Intensive Care Unit (clarithromycin); concentration
patient allergic to frequently
penicillin can be
given second Provide oxygen
generation therapy as
(cefuroxime) or recommended
third generation
(cefotaxime or •Administer
ceftriaxone)

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 cephalosporin plus intravenous fluids
clarithromycin. In
case of • Provide nutritional
Pseudomonas support
infection,
ceftazidime plus • Perform repeated
gentamicin or chest X-rays to
tobramycin. monitor progress
Alternatively,
ciprofloxacin or
piperacillin, plus
gentamicin or
tobramycin.

NURSING MANAGEMENT

Nursing Assessment

◆ Assess the patient for signs and symptoms of impaired respiratory

function such as tachypnoea, increased work of breathing, shortness
of breath, presence of cough, restlessness, irritability, altered mental
status, pleuritic chest pain, abnormal breath sounds such as crackles
and rales.

◆ Assess sputum production for its colour, consistency, and amount.

◆ Monitor ABG values for presence of respiratory acidosis.

◆ Monitor intake and output record of the patient. Assess the patient

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for signs and symptoms of deficient fluid-volume such as decreased
skin turgor, decreased urine output, dry mucous membranes,
increased thirst, increased or decreased respiratory rate, falling blood
pressure, weak and rapid pulse.

◆Assess nutritional status of patient through oral intake of diet

containing nutrients. Assess for the presence of anorexia, nausea and
vomiting.

◆Assess the patient for the disturbed sleep, presence of fear and
anxiety related to disease condition, prognosis, and hospitalization.

Nursing Diagnoses

◆Ineffective breathing pattern related to chest pain, dyspnea, fear,

anxiety, and presence of infection.

◆Ineffective airway clearance related to production of large amount

of tenacious secretions and inability to cough up the secretions.

◆Impaired gaseous exchange related to ineffective brea- thing

pattern, impaired airway patency, and decreased gas exchange surface
due to accumulation of secretions in the lungs.

◆Deficit fluid-volume related to deceased intake of fluid due to

dyspnea, anorexia, and nausea.

◆ Imbalanced nutrition: Less than body requirements due to

anorexia, nausea, and increased metabolic rate.

◆ Activity intolerance related to impaired gas exchange, decreased

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rest and sleep periods, and malnutrition.

Nursing Interventions

Improving Breathing Pattern

◆ Provide Fowler's or semi-Fowler's position to the patient to

increase thoracic volume for maximum chest expansion.

◆ Demonstrate and encourage patient to perform coughing and deep

breathing exercises.

◆Instruct patient to change position every 2 hourly.

◆Provide oxygen therapy to the patient as prescribed. Ensure that

humidified oxygen is delivered to the patient as the dry oxygen
irritates mucosa.

◆Provide warm and humidified environment to the patient.

◆Administer antitussives and pain-relieving medications as

prescribed to the patient.

◆Provide frequent rest periods in between periods of activity to avoid

exertion and fatigue.

◆Provide well-balanced nutritious diet to facilitate easy recovery.

◆Initiate measures to alleviate fear and anxiety. Provide

psychological support to the patient.

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Maintaining Airway Patency

◆ Provide Fowler's or semi-Fowler's position to the patient with head

maintained in midline or slight extension position to open the airway
and increase thoracic volume for maximum chest expansion.

◆Encourage patient to consume plenty of fluids to liquefy secretions

to aid in easy removal.

◆Demonstrate and encourage patient to perform coughing and deep

breathing exercises.

◆Perform bronchial hygiene techniques to facilitate clearance of the

airway such as postural drainage followed by chest physiotherapy
using percussion, vibration, coughing, and huffing techniques.

◆Encourage patient to ambulate so as to prevent consolidation of

lungs with secretions in the chest.

◆If not possible to cough out the secretions, suction the secretions
from the airway.

◆ Provide warm and humidified environment to the patient.

◆ Provide nebulization to the patient with mucolytic agents as

prescribed.

Improving Gaseous Exchange

◆ Provide sitting or high-Fowler's position to the patient to facilitate

maximal chest expansion.
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◆Provide side lying position with the good lung down as the gravity
and hydrostatic pressure lead to better ventilation and oxygenation of
the dependent lung.

◆Change the position of the patient frequently as the patient may get
tired due to increased work of breathing.

◆Consider oxygen administration using an appropriate oxygen

delivery device with aim to improve partial pressure of oxygen in
atrial blood.

◆Assess the ability of the patient to cough and clear secretions. If not
possible, suction the secretions as necessary.

Maintaining Adequate Fluid Volume Status

◆Increase oral intake of fluids of the patient to 3-4 liters/ day.

◆f oral intake of fluids is not feasible or not sufficient, consider

intravenous administration of fluids.

◆Administer antiemetics, if persistent nausea and vomiting is

present.

◆Monitor intake-output record of the patient.

◆Monitor vital signs of the patient frequently.

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Improving Nutritional Status of the Patient

◆Provide small and frequent meals to the patient.

◆If patient is not able to take solid foods because of shortness of

breath, consider energy containing drinks and fluids containing
calories and electrolytes.

◆Administer antiemetics, if persistent nausea and vomiting is

present.

Improve Activity Tolerance

◆ Develop realistic plan for meeting daily physical needs along with
the patient.

◆ Schedule nursing at the time when the patient is most able to

participate such as couple of hours after getting up in the morning,
after scheduled rest periods, not after meals and treatment when the
patient is already fatigued.

◆ Keep objects of personal use within easy reach.

◆ Increase patient's activity gradually as allowed and tolerated; assist

with graded exercises and physical conditioning program (measured
levels walk, treadmill, stationary bicycle, etc.) as ordered.

◆ Allow adequate time to the patient for the accomplishment of self-

care activities.

◆Assist the patient in performing those activities which the patient is

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 not able to perform independently.

◆ Provide positive feedback to the patient for all efforts and

accomplishments of self-care.
Identify the
9. 2min complication ◆ Provide frequent periods of rest and activity. PPT Lecture Listen Which are the
of pneumonia cum carefully complication
Maintaining Normal Body Temperature discussion of Pneumonia?

◆Assess the patient for the signs and symptoms of hyperthermia such
as (elevated body temperature, increased respiratory rate and heart
rate, warm and flushed skin).

◆ Provide tepid sponging to the patient.

◆Provide well-ventilated room. Remove extra clothing and blankets

from the patient.

◆ Provide plenty of fluids to prevent dehydration due to diaphoresis

◆Provide periods of rest.

◆Provide well-balanced nutritious diet to the patient.

COMPLICATIONS

Most cases of pneumonia generally run an uncomplicated course.

However, complications can occur, and they develop more frequently
in individuals with underlying chronic diseases and other risk factors.
Complications may include the following:

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 1. Pleurisy (inflammation of the pleura) is relatively common.

2. Pleural effusion (transudate fluid in the pleural space) can occur.

It develops in 40% of hospitalized patients with pneumococcal
pneumonia. Usually, the effusion is sterile and is reabsorbed in 1 to 2
weeks; occasionally, effusions require aspiration by means of
thoracentesis.

3. Atelectasis (collapsed, airless alveoli) of one or part of one lobe

may occur. These areas usually clear with effective coughing and
deep breathing.

4. Bacteraemia (bacterial infection in the blood) occurs in 30% of

patients with pneumococcal pneumonia and is associated with a 20%
mortality rate. The rate can go as high as 60% in elderly patients.

5. Lung abscess is not a common complication of pneumonia. It is

seen with pneumonia caused by S. aureus and Gram- negative
To do pneumonias (see the section on Lung Abscess later in this chapter).
10. 1.min. summarization PPT
6. Empyema (accumulation of purulent exudate in the pleural cavity)
is relatively infrequent (occurs in <5% of cases) but requires
antibiotic therapy and drainage of the exudate by a chest tube or open
surgical drainage.

7. Pericarditis results from spread of the infecting organism from an

infected pleura or via a hematogenous route to the pericar- dium
(fibroserous sac around the heart).

8. Meningitis can be caused by S. pneumoniae. The patient with

pneumonia who is disoriented, confused, or somnolent should have a

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 To do lumbar puncture to evaluate the possibility of meningitis. Recapitalizatio
11. 1.mnt recapitalizatio PPT n
n 9. Endocarditis can develop when the organisms attack the
endocardium and the valves of the heart. The clinical manifestations
are similar to those of acute bacterial endocarditis

SUMMARIZATION

Today, on this session we have discussed about peptic ulcer. We have

discussed about:

 Definition of Pneumonia
 Types of Pneumonia
 Causes of Pneumonia
 Sign and Symptoms of Pneumonia
 Diagnostic Studies of Pneumonia
 Management of Pneumonia
 Complication of Pneumonia

RECAPTUALIZATION
Enlist the Causes of Pneumonia?
Enumerate the sign and symptoms of Pneumonia?
Explain the complications of Pneumonia?

REFERENCES
1. Suddharth’s and Brunner’s, “A Text Book of Medical Surgical Nursing”, 13th edition, page no. 632-639 published by Wolters Kluwer.
2. Lewis’s, “A Text Book Of Medical Surgical Nursing”, 4th edition, Page no. 489-496published by Elsevier.
3. Black’s “Adult Health Nursing-I” Volume-I, Jaypee Publications, Page No: 337-340.
4. https://en.wikipedia.org/wiki/Pneumonia
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5. https://pmc.ncbi.nlm.nih.gov/articles/PMC7241411/

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