Answer: 40%
Explanation:
Subjective: Here to follow up on her atrial fibrillation. No new problems. Feeling well. Medications are per medication sheet. These were reconstituted with the medications that she was discharged home on. Objective: Blood pressure is 110/64. Pulse is regular at 72. Neck is supple. Chest is clear. Cardiac normal sinus rhythm. Assessment: Atrial fibrillation, currently stable. Plan: 1. Prothrombin time to monitor long term use of anticoagulant. 2. Follow up with me in one month or sooner as needed if she has any other problems in the meantime. Will also check a creatinine and potassium today. What diagnosis code(s) are reported
Diagnosis code(s) are reported :
F03.90M25.511I11.9E11.9Diagnosis codeTo categorize and identify illnesses, disorders, symptoms, poisonings, negative effects of medications and chemicals, injuries, and other causes for patient contacts, diagnostic codes are employed in the medical field. Diagnostic coding is the process of converting textual descriptions of ailments, injuries, and diseases into codes that fall under a certain categorization.
In the clinical coding procedure for medical categorization, diagnostic codes are utilized with intervention codes. A medical classification expert such as a clinical coder or a health information manager assigns the diagnostic and intervention codes.
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The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care
The most effective method of getting staff nurses to incorporate a new evidence-based practice into their care would be through education and training.
Education and training are key to the successful implementation of a new evidence-based practice. The nurse manager should start by providing the staff nurses with information about the revised policy and procedure on central line catheter care, including the evidence that supports it and how it differs from current practice. The manager should also provide opportunities for the staff nurses to ask questions and provide feedback, which can help to address any concerns they may have. After this,the manager should provide hands-on training and give the staff nurses the opportunity to practice the new skills in a safe and controlled environment. Finally, the manager should provide ongoing support, including regular check-ins and supervision, to ensure that the staff nurses are able to consistently implement the new practice and provide quality care to patients. In addition, regular feedback and evaluation of the new practice implementation will be helpful to measure the effectiveness of the new practice and make necessary adjustments.
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Which of the following statements regarding normal gas exchange in the lungs is correct?
A. The oxygen content in the alveoli is highest during the exhalation phase.
B. Blood that returns to the lungs from the body has low levels of carbon dioxide.
C. The actual exchange of oxygen and carbon dioxide occurs in the capillaries.
D. Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.
During gas exchange in the lungs, oxygen and carbon dioxide diffuse across the alveolar walls and capillaries into the bloodstream. The process is called external respiration.
Air, essentially oxygen, is inhaled through the nose, travels through the pharynx and larynx to reach the trachea. The trachea divides into two parts- the left bronchus and the right bronchus. These two bronchus divide further into smaller bronchioles. The bronchioles which are smallest in size contain tiny air sacs at the end, which are called alveoli. During respiration, oxygen moves from lungs into blood and carbon dioxide does the exact opposite and passes from the bloodstream into the lungs. Red blood cells (RBCs) pass through capillaries, which are a small formation of blood vessels. The alveoli and capillaries share the same wall or membrane so when oxygen or carbon dioxide passes through or from the blood stream, respectively, the RBCs take up oxygen from the alveoli and passes back carbon dioxide into the lungs to be exhaled out. This process is necessary for survival.
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Steven is about to start his second round of chemotherapy. His chemotherapy medication is dosed by his BSA. He weighs 200 lb and is 72 in tall. What is his BSA
2.15 m2 start his second round of chemotherapy. His chemotherapy medication is dosed by his BSA. He weighs 200 lb and is 72
Chemotherapy is used at what stage of cancer?
Chemotherapy and/or targeted therapies are the principal treatments for extensive stage 4 colon cancer. Your care team may recommend surgery to treat that specific location and treat symptoms if the cancer is encroaching on other organs or producing specific symptoms.Is chemotherapy only used for cancer?
Chemotherapy is a common family of medications used to treat a wide range of illnesses, including but not limited to: malignancies, blood problems, and a wide range of autoimmune diseases. Similar to how it can be given orally, topically, intravenously, or subcutaneously, it can also be given in many other ways.
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When Vatican II convened, it was decided that the Sacrament of Anointing of the Sick should be both a sacrament of healing and a sacrament to prepare those who are dying.
A Christian rite that is acknowledged as being exceptionally significant and vital is called a sacrament. The presence, number, and significance of such rites, there are numerous points of view.
Many Christians view the sacraments as both a vehicle for God's mercy and a tangible proof of God's actuality. Many religious groups adhere to Augustine of Hippo's definition of a sacrament, which is as follows: an outward indication of an internal grace that has been instituted by Jesus Christ. These groups include the Catholic, Lutheran, Anglican, Methodist, and Reformed. Sacraments represent God's grace in a tangible way that the participant may see.
Vatican II, which was the 21st ecumenical council of the Catholic Church, was held from 1962 to 1965. One of the decisions made during the council was to revise the understanding and practice of the sacrament of Anointing of the Sick, also known as Last Rites or Extreme Unction. Prior to the council, the sacrament was primarily associated with the forgiveness of sins for those on their deathbeds. However, Vatican II emphasized that the sacrament should also be understood as a sacrament of healing, to be given to those who are ill, as well as to those who are approaching death. This change in understanding and practice was reflected in the revised Rite of Anointing, which was issued following the council.
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The term medically managed means that even though a diagnosis may not receive direct treatment during an encounter:
It must be taken into account while deciding how to treat other conditions.
Even while a diagnosis might not get immediate treatment during an encounter, it must be taken into consideration when deciding how to treat other diseases, according to the definition of the word "medically managed."The V codes of the ICD-9, which list the causes of medical encounters other than illness or injury, contain the codes for preventative treatments. For a typical general medical examination carried out at a healthcare facility, V70. 0 should be utilised, and V70.Codes from ICD-9-CM are ready to deal for encounters with conditions other than illness or injury. Factors Affecting Health Status & Contact with Health Services: Supplementary Classification (V01.
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The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of
The nurse understands that a child of this age is at increased risk of accidental ingestion due to a less discriminating sense of taste.
Caustic ingestion happens when a person inadvertently or intentionally consumes a caustic or corrosive material. Depending on the type of the material, the length of exposure, and other conditions, it can cause varied degrees of damage to the oral mucosa, oesophagus, and stomach lining.
Endoscopy of the upper digestive system can identify the degree of the damage, but CT scanning may be more beneficial in determining whether surgery is necessary. During the healing phase, oesophageal strictures may occur, necessitating therapeutic dilatation and the insertion of a stent. Ingestions of acids with pH less than 2 or alkalis with pH greater than 12 can result in the most severe damage.
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Select the correct answer. It may be healthier to be slightly overweight than to experience weight cycling. A. True B. False
Choose the right response. It is true that maintaining a stable weight rather than experiencing weight cycling may be healthier.
Weight cycling: what is it?Yo-yo dieting, often known as weight cycling, is the practise of intermittently losing and gaining weight. Weight-loss therapies are useless for all but a small number of people over the long term, according to a large body of studies. In reality, it's quite uncommon for someone to "reduce weight and keep it off."
For instance, a 2007 evaluation of long-term weight-reduction trials (Mann et al. 2007; CW for weight-stigmatizing terminology) discovered that the average weight loss maintained across therapies was only a few pounds, meaning that persons who began in the "obese" BMI category stayed there.
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If an employee/student/patient has medical testing at an HCA facility, the appropriate way for him or her to access the test results is:
The appropriate way to access the test results when an employee/student/patient undergoes medical testing at an HCA facility is: to complete the release form and receive a copy of results.
Medical testing is the procedure performed to detect, diagnose or monitor any disease. The medical testing usually involves the testing of fluid sample of the body like blood, urine, serum, etc. Body imaging tests like X-rays are also a type of medical testing.
HCA refers to the Hospital Corporation of America. It is an organization that acts as the operator of the health care facilities for the citizens of America. It was established in the year 1968.
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A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which
A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which serum potassium level
What impacts the heart does Lanoxin have?
It functions by having an impact on specific minerals (sodium and potassium) within cardiac cells. As a result, the heart is put under less stress and is better able to keep up a regular, steady beating.What are the uses of Lanoxin tablets?
Heart failure is treated with lanoxin. Atrial fibrillation, a condition affecting the atria's heart rhythm, is similarly treated with lanoxin (the upper chambers of the heart that allow blood to flow into the heart)
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During the primary assessment of a semiconscious 70-year-old female, you should:
Select one:
A. ensure a patent airway and support ventilation as needed.
B. immediately determine the patient's blood glucose level.
C. insert a nasopharyngeal airway and assist ventilations.
D. ask family members if the patient has a history of stroke.
During the primary assessment of a 70 year old subconscious female, it is important to ensure a patient’s airway and support ventilation as needed.
This should be done in order to check for signs of stroke to check breathing and circulation of blood to the brain. When blood flow to the brain is obstructed, it leads to losing consciousness and partial paralysis which is a symptom of stroke. When blood flow to the brain is cut-off, it prevents the tissues in the brain from taking up nutrients and oxygen which results in the death of brain cells, which further causes brain death. Fast diagnosis is important for patients in such critical conditions. This may be caused due to high blood pressure or high glucose levels in the patient’s blood.
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why is it important to list and prioritize your short-, mid-, and long-term goals ahead of time?
It is important to set short-term goals so that you don't try to overwork yourself by doing to much stuff at once. It is important to set long-term goals so that you can have a plan for your life, so that you aren't wandering around aimlessly
Why is it important to set long time goals?Your daydreams can become tangible aspirations that you can actively pursue by setting long-term goals. They can not only assist you in completing challenging tasks, but they can also be a helpful tool in helping you organize your workload and determine what success means to you. Setting short-term goals is essential to avoid trying to take on too much at once and overworking yourself. Setting long-term objectives will help you organize your life and prevent you from stumbling around aimlessly. Short-term objectives concentrate on the here-and-now. They focus on making the most of what you have or will have soon. Long-term objectives relate to the kind of person you hope to become.Setting short-term goals is essential to avoid trying to take on too much at once and overworking yourself. Setting long-term objectives will help you organize your life and prevent you from stumbling around aimlessly.To learn more about set long time goals refer to:
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George suffers from pain in his neck due to continuous typing for long hours. What kind of exercise can George do for his neck
George suffers from pain in his neck due to continuous typing for long hours. George should perform chin tucks and try massages with ice or heat.
The neck is the group of structures that link the head to the body. It is a complicated structure made up of several bones, muscles, nerves, blood vessels, lymphatics, and connective tissues. Depending on the reason, neck discomfort, or cervicalgia, can continue for days to years. Physical strain, bad posture, emotional stress, osteoarthritis, spinal stenosis, ruptured disc, pinched nerve, malignancies, and other health issues are all common causes.
Neck discomfort is occasionally an indication of a more serious issue. Seek medical attention if you have neck discomfort with numbness or lack of strength in your arms or hands, or if you have pain that shoots into your shoulder or down your arm.
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When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate
initial response was 1)tells you that she is only a social drinker. Which initial response is appropriate and "What amount and what kind of alcohol do you drink in a week"
What is known as alcohol?
a molecule present in beverages including beer, wine, and liquor. Some medications, mouthwashes, home goods, and essential oils also contain it (scented liquid taken from certain plants). It is produced using yeast and carbohydrates in a chemical process known as fermentation.Alcohol use is linked to a number of short- and long-term health hazards, including blood pressure problems, aggression, risky sexual activity, and numerous malignancies (e.g., breast cancer). With each additional drink, the risk of these negative effects grows.
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the nurse is caring for a native american client during labor. What does the nurse keep in mind about the client's cultural approach to pain
The nurse remembers the client's cultural approach to pain and that the client may use 383 indigenous plant medicines.
Pain management is sometimes difficult for medical practitioners. This is exacerbated while the patient is dying. Health practitioners and teams that understand cultural differences are rewarded with both the knowledge that they are more effective in controlling their patients' pain. They are also better equipped to assist their patients' families and friends in adjusting towards the dying process. Considering the patients' and their families' views, experiences, and values increases the quality of medical treatment offered. Only the patient perceives pain, and only the patient may report it.
Palliative care, focusing on symptom control and comfort measures, relieves suffering in patients with life-threatening illnesses and maximizes their quality of life. Palliative care may be necessary for patients diagnosed with cancer, degenerative neurologic diseases, painful neurologic diseases, and those diagnosed with chronic obstructive pulmonary disease to relieve symptoms of breathlessness.
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A nurse is teaching first aid to counselors of a summer camp for children with asthma. This is an example of what aim of health teaching
This is an example of the aim of health promotion and preventing illness, or disease prevention in health teaching.
By teaching first aid to counselors of a summer camp for children with asthma, the nurse is providing them with the information and skills they need to identify and respond to asthma symptoms and emergencies, which can help to prevent illness and promote the health and well-being of the children at the camp.
The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion
The nurse is inserting a nasogastric tube for a patient with pancreatitis. The nurse's intervetion is that as the tube is being put in, let the patient drink some water.
A plastic tube is inserted through the nose, down the oesophagus, and into the stomach during a procedure known as nasogastric tubation. A comparable procedure involves inserting a plastic tube into the mouth during orogastric intubation. The NG tube was created by Abraham Louis Levin.
The nose, throat, and stomach are all entered by a small, soft tube known as a nasogastric (NG) tube. The formula is typically given to children who are unable to eat by mouth. Children occasionally receive medicine through a tube.
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The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is:
The job description of the nursing manager in understanding case management for the new rehabilitation unit to help reduce costs is the coordination of resources for effective outcomes.
Nursing management is a form of coordination and integration of nursing resources by implementing management processes to achieve the goals and objectivity of nursing care.
The nurse manager is a nurse who is responsible for a unit in a hospital or clinic. The task of the nursing manager is to plan, organize, direct and supervise the existing finances, equipment, and human resources to provide effective and economical treatment to patients.
This question is multiple choice:
a. Managing of care by nurse managers.b. Coordination of resources for effective outcomes.c. Rapid discharge of clients to decrease costs.d. Managing care for outpatient clients only.The correct answer is B.
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The health care provider has just prescribed tetracycline for an adolescent with acne vulgaris. The client takes oral contraceptive pills. The clinic nurse should educate the teen about which topics? Select all that apply.
1. Not taking tetracycline with dairy products
2. Taking tetracycline at bedtime
3. Taking tetracycline with food
4. Using additional contraceptive techniques
5. Using sunblock
The nurse at the clinic needs to teach the teen which subjects are Sunscreen use, supplementary forms of contraception, and avoiding taking tetracycline with dairy items.
What is tetracycline?Tetracycline is used to treat bacterial infections that affect the skin, eye, lymphatic, intestinal, vaginal, and urinary systems, as well as a few additional infections that are transferred by ticks, lice, mites, and infected animals. These infections include pneumonia and other respiratory tract infections. To treat acne, it is often used in combination with other drugs. As a treatment for plague and tuleramia, tetracycline is also utilised (serious infections that may be spread on purpose as part of a bioterror attack).
Various forms of food poisoning and anthrax can also be treated with it in patients who are ineligible for penicillin treatment.
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The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 10. Which nursing action is best
Schedule a health care provider appointment for one week is the best nursing action.
A biophysical profile is a test that is performed after the 28th week of pregnancy. This noninvasive diagnostic test aids in determining the health of the foetus. Body movement, muscle tone, breathing movement, heart rate, and amniotic fluid level are all measured. A biophysical profile is a prenatal ultrasound examination of foetal well-being that employs a scoring system, the result of which is known as Manning's score. It is frequently used when a non-stress test is inconclusive or for other obstetrical purposes.
Each assessment is assessed with either 0 or 2 points, and the total is between 0 and 10. A BPP of 8 or 10 is often thought to be comforting. Because foetal movements do not occur in the first half of a pregnancy, a BPP is usually not conducted before the second half.
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what is the primary difference between an automatic aed and a semi-automatic aed?
Semi-automatic AEDs will ask the rescuer to press a button to deliver a shock to the victim, thus leaving it up to them to actually deliver the treatment.
What does an automatic AED do?Semi-automatic and fully-automatic variants are available from a number of automated external defibrillator (AED) manufacturers, including Cardiac Science, Defibtech, Heart Sine, Physio-Control, and Zoll. The AED automatically assesses the patient's heart rhythm while the pads are in place and decides whether a shock is required. The device instructs the user to stand back and press a button to give the shock if it is. When a shock is not necessary, the AED is programmed not to administer one. Semi-automatic AEDs leave it up to the rescuer to administer the treatment by asking them to click a button to shock the victim. On the other hand, fully automatic AEDs automate the entire procedure and deliver the shock automatically.To learn more about automatic AED refer to:
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A majority of the land in the Middle East is unsuitable for crops because
ocean water cannot be converted to freshwater.
freshwater sources are scarce in the region.
people cannot live in these desert areas.
mountains block water from coming inland
Most of the Middle East's land is unsuited for farming because mountains prevent water from entering the interior.
Why is farming in the Middle East so challenging?The world population is expected to exceed 10 billion people by 2050, and there will be a growing gap between the amount of agricultural products produced and the foods that will be needed. Growing urbanisation activities and severe climatic change contribute to soil degradation, which reduces the amount of arable land and increases water shortages, resulting in low agricultural output and supply chain problems.
Due to severe weather, an arid climate, and a lack of natural resources that make agriculture production difficult, the Middle East regions still rely heavily on imports to supply the population's food demands.
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the nurse is caring for a client who has just expired. which action will the nurse perform?
A deceased person's body is always treated with dignity. Every nurse has an obligation to accommodate their patient’s wishes regarding their end-of-life care preferences. The nurse ensures that each patient's dying process goes as smoothly as possible. Here are some of the steps that every nurse takes when caring for a client who has recently died.
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In preparation for a vaginal delivery of a patient at term, the nurse has set up the delivery table with instruments and checked the infant warmer for suction and resuscitation equipment. What health care team members should be present at every delivery in order to adequately care for the newborn
The healthcare team member who must be present at every delivery to care for the newborn adequately is one health team member capable of performing the initial steps of newborn resuscitation and PPV.
The health team responsible for performing newborn resuscitation and PPV (pulmonary protective ventilation) must be present at every delivery. Pediatricians, neonatologists, neonatal nurse practitioners, pediatric nurses, neonatal intensive care unit nurses, or respiratory therapists are not needed except in very specific circumstances.
This question is multiple choice:
A. A pediatrician, a pediatric nurse, and a respiratory therapistB. A neonatal nurse practitioner and a respiratory therapistC. At least one healthcare team member capable of performing the initial steps of newborn resuscitation and PPVD. A neonatologist, a neonatal intensive care unit nurse, and a respiratory therapistC. At least one healthcare team member capable of performing the initial steps of newborn resuscitation and PPVThe correct answer is C
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You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now
The most important assessment step for a patient when his pulse oximetry reading is 97% is obtaining a 12-lead ECG.
An electrocardiograph (ECG) is a common diagnostic test used to evaluate heart function. ECG is the reflection of the electrical activity of the heart muscle fibers in a stroke. The ECG image is a graph of the potential difference between two points on the body surface.
Its use is to determine abnormalities in the heart such as heart rhythm disturbances, disorders of the heart muscle, presence of heart enlargement, electrolyte disturbances, presence of pericarditis, and the influence of heart medications. An ECG examination can be done once a year through an annual routine medical check-up or if necessary, according to a doctor's indication.
During the examination, the patient is asked to lie in bed with the chest area free of clothing and free of jewelry. The patient must be calm and not move much. Next, the electrodes will be installed by attaching the electrodes that have been given gel to the chest. The officer will check and print the ECG results.
The question is multiple choice:
A. PETCO₂
B. Chest x-ray
C. Laboratory testing
D. Obtaining a 12-lead ECG
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A newborn develops physiologic jaundice, and the mother asks the nurse why this happened. Which response by the nurse would be most accurate
The nurse's reaction would be the most accurate because his liver is a bit immature, the baby can't break down the bilirubin as fast as needed.
Most neonates acquire physiological jaundice during the second or the third day of life. When your baby's liver matures, it will begin to eliminate excess bilirubin. Physiological jaundice is typically not dangerous and resolves itself within two weeks.
The infant exhibits physiologic jaundice, which would be caused by a reduction in bilirubin conjugation. Because newborns' livers are still developing, they cannot conjugate (break down) bilirubin as quickly as they should. Overproduction of bilirubin is to blame for jaundice caused by blood incompatibility. Impaired bilirubin excretion, as a result of a biliary tree blockage, can also cause jaundice. The origins of infant jaundice are well understood; jaundice is generally caused by one of these three processes.
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Which of the following statements regarding pelvic inflammatory disease (PID) is correct?
a. The most severe cases of PID occur in women who are not sexually active.
b. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.
c. PID most commonly affects women who have had an ectopic pregnancy in the past.
d. The most common presenting symptom of PID is generalized upper abdominal pain.
Statement B is correct regarding pelvic inflammatory disease (PID) is correct: PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.
A female reproductive system infection is known as pelvic inflammatory disease (the cervix, uterus, fallopian tubes, and ovaries). Women who are sexually active are typically affected by pelvic inflammatory disease. Women who have experienced pelvic inflammatory illness are 6–10 times more likely to experience a tubal pregnancy (a form of ectopic pregnancy). The fetus develops in a fallopian tube rather than the uterus during a tubal pregnancy. The woman's life is in danger during this type of pregnancy, and the fetus is not viable. Therefore, option B is he appropriate answer.
Women typically experience lower abdominal pain, vaginal discharge, and erratic vaginal bleeding. The diagnosis is made using the patient's symptoms, examination of vaginal and cervix secretions, and occasionally ultrasonography. Using condoms and restricting sexual activity to one partner lower the risk of contracting an infection.
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which of the followiing vital signs indicate increased pressure within the skull following head trau,a
Vital signs indicating increased pressure in the skull after head trauma are headache, double vision, and increased blood pressure.
What is pressure in the skull?Pressure in the skull is also known as intracranial pressure. This pressure can show the condition of brain tissue, cerebrospinal fluid, and brain blood vessels. Under certain conditions, intracranial pressure can increase and cause certain symptoms that need to be watched out for.
Raised intracranial pressure left untreated can lead to serious, life-threatening conditions. Symptoms include nausea and vomiting, headaches, increased blood pressure, and double vision.
Your question is incomplete. maybe the point of your question is
Which of the following vital signs indicate increased pressure within the skull following head trauma?
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A group of grade-school children is going camping. As a school nurse, you would offer them which advice to prevent Lyme disease?
a) "Don't approach strange animals outside the campsite."
b) "Don't drink water from mountain streams while hiking."
c) "Don't touch any bush without knowing what kind it is."
d) "Wear jeans tucked inside your socks when in the woods."
Advise the children to "Wear jeans tucked inside your socks when in the woods" to prevent Lyme disease.
What is mean by Lyme disease? How to prevent Lyme disease?Lyme disease is an infection caused by a type of bacteria called Borrelia burgdorferi, which is spread by ticks.
Symptoms of the disease may include a rash, fever, chills, headache, joint pain, fatigue, and swollen lymph nodes.
If left untreated, it can cause serious complications, such as arthritis, meningitis, and heart problems.
To prevent Lyme disease, it's important to take precautions when spending time outdoors.
Wear light-colored clothing and long pants and sleeves, use insect repellent, and check yourself and your family for ticks after being outdoors.
Additionally, it's important to avoid areas with tall grass and brush, as ticks often hide in these areas.
If ticks are found on you, be sure to remove them promptly. If you develop any symptoms of Lyme disease, be sure to see a doctor right away.
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Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage
Answer:
Botanically, a fruit is a mature ovary and its associated parts. It usually contains seeds, which have developed from the enclosed ovule after fertilization, although development without fertilization, called parthenocarpy, is known, for example, in bananas.