Please enable it to take advantage of the complete set of features! Chapter 72. Retrieved April 2, 2020, from https://www.merriam-webster.com/dictionary/eclampsia, New Guidelines in Preeclampsia Diagnosis and Care Include Revised Definition of Preeclampsia. Calcium supplementation decreases the incidence of hypertension and preeclampsia, respectively, among all women (NNT = 11 and NNT = 20), women at high risk of hypertensive disorders (NNT = 2 and NNT = 6), and women with low calcium intake (NNT = 6 and NNT = 13). Sometimes healthcare providers will have you collect your urine for 12 or 24 hours to determine the exact quantity of protein in the urine. A physical examination may be performed, as well as a test of the deep tendon reflexes. The rooting reflex is present if stroking the lateral upper lip causes movement of the mouth toward the stimulus. Hypertensive disorders represent the most common medical complication of pregnancy, affecting 6 to 8 percent of gestations in the United States.1 In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension.1, Chronic hypertension is defined as a blood pressure measurement of 140/90 mm Hg or more on two occasions before 20 weeks of gestation or persisting beyond 12 weeks postpartum.1 Treatment of mild to moderate chronic hypertension neither benefits the fetus nor prevents preeclampsia.24 Excessively lowering blood pressure may result in decreased placental perfusion and adverse perinatal outcomes.5 When a patient's blood pressure is persistently greater than 150 to 180/100 to 110 mm Hg, pharmacologic treatment is needed to prevent maternal end-organ damage.1,2,4,6, Methyldopa (Aldomet; brand no longer available in the United States), labetalol, and nifedipine (Procardia) are oral agents commonly used to treat chronic hypertension in pregnancy. Fetal growth may be assessed by serial fundal height measurements supplemented by ultrasonography every four weeks starting at 28 weeks of gestation.4, Gestational hypertension has replaced the term pregnancy-induced hypertension to describe women who develop hypertension without proteinuria after 20 weeks of gestation.1 Gestational hypertension is a provisional diagnosis that includes women eventually diagnosed with preeclampsia or chronic hypertension, as well as women retrospectively diagnosed with transient hypertension of pregnancy. A second opinion regarding the patient's diagnosis and management also should be considered before initiating long-term opioid therapy. You checked the deep tendon reflexes. Most patients with preeclampsia respond promptly to delivery with decreased blood pressure, diuresis, and clinical improvement. Did you discuss this with your doctor at the time of exam? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Assess serum magnesium level if urine output is < 30 mL per hour or there is a loss of deep tendon reflexes, decreased respiratory rate, or altered mental status Therapeutic range for serum. The neuropathies must be further characterized by onset and chronicity of symptoms, the pattern and extent of involvement, and the type of nerve fibers involved (i.e., sensory, motor, or autonomic). Some . The use of magnesium sulfate for seizure prophylaxis in women with mild preeclampsia is controversial because of the low incidence of seizures in this population. MeSH There are no reliable data on postpartum hypertensive management50; however, oral nifedipine is commonly used.7, An eclamptic seizure may be preceded by increasingly severe preeclampsia, or it may appear unexpectedly in a patient with minimally elevated blood pressure and no proteinuria. This is because preeclampsia temporarily damages this filter. Albumin, as well as many other proteins, are lost this way. In the early stages of peripheral neuropathy, patients typically present with progressive symptoms, including sensory loss, numbness, and pain or burning sensations in distal limbs in a stocking and glove distribution. A total of 8 g of magnesium sulfate should not be exceeded over a short period of time.43,53. As the nurse, you want to watch out for the following measurements: How is preeclampsia different than gestational hypertension? Therefore, water will leave the intravascular area and shift to the interstitial tissue and cause swelling. Morning sickness should disappear after the first trimester and the sudden appearance of nausea and vomiting after mid pregnancy may be linked to preeclampsia. please help, this is urgent. What is the definition or description of: deep tendon reflex? 2022 Jun 27. Brisk reflexes are the result of an irritable cortex and indicate central nervous system involvement, and potential for seizures Eliciting the deep tendon reflexes is a vital component of medical assessments in general practice (where 9% of medical problems are believed to be neurological in origin 1) and in hospital (where 10-20% of admissions have a primary neurological problem 2).Reflex testing contributes to accurate bedside diagnosis in many cases of neuromuscular disease, providing localising diagnostic . Many patients have a history of malaise or nonspecific symptoms suggesting an acute viral syndrome.33 Any patient with these symptoms or signs of preeclampsia should be evaluated with complete blood count, platelet count, and liver enzyme determinations.34. Here is everything you need to know about taking your blood pressure at home. The peripheral nerves consist of bundles of long neuronal axons as they exit the central nervous system (CNS). Magnesium sulfate is the drug of choice to prevent and treat eclampsia. Severe preeclampsia condition can lead to: To help us take everything we learned about the patho and signs and symptoms and incorporate it with the nursing interventions and treatment, lets remember the word: Proteinuria monitoring: check urine for protein at every prenatal visit (some women may be taught to do this at home with a dipstick test): Reflexes hyperactive (deep tendon reflexespatellar and bicep), Evaluate blood pressure for hypertension: monitored at every prenatal visit and educate mother to monitor at home. Patients with treatment-resistant severe hypertension or other signs of maternal or fetal deterioration should be delivered within 24 hours, irrespective of gestational age or fetal lung maturity. I need your help please? Preeclampsia is characterized as mild or severe based on the degree of hypertension and proteinuria, and the presence of symptoms resulting from involvement of the kidneys, brain, liver, and cardiovascular system (Table 2).12 Severe headache, visual disturbances, and hyperreflexia may signal impending eclampsia. We joined a number of maternal health organizations How to Handle Prenatal and Postpartum Appointments, From Home The cerebral cortex and a number of brainstem nuclei exert influence over the sensory input of the muscle spindles by means of the gamma motoneurons that are located in the anterior horn; these neurons supply a set of muscle fibers that control the length of the muscle spindle itself. Hyperreflexia is seen with pre-eclampsia During a reflex test, your muscle shortens (contracts) in response to deep tendon taps from the reflex hammer. Treasure Island (FL): StatPearls Publishing; 2022 Jan. We encourage you to familiarize yourself with signs and symptoms included here to empower yourself and/or others during pregnancy. Treating 69 women prevents one case of preeclampsia; treating 227 women prevents one fetal death.27 For women at highest risk from previous severe preeclampsia, diabetes, chronic hypertension, or renal or autoimmune disease, only 18 need to be treated with low-dose aspirin to prevent one case of preeclampsia.27. +2= Normal reflex High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions at least four hours apart. Damage to the nerves, as in clonus,. Learning more about the signs and symptoms of preeclampsia, HELLP syndrome and other hypertensive disorders of pregnancy can help you identify a problem early and ensure the best possible outcome. 2 1 The nurse should check the clients patellar reflexes The most common way to. Contact your healthcare provider immediately if these symptoms are new. +4= Hyperactive reflex; clonus may also be present, +1 Minimal edema of lower extremities Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia. During pregnancy, a rise in the lower number (diastolic) of 15 degrees or more, or a rise in the upper number (systolic) of 30 degrees or more can also be a cause for concern. EKG Rhythms | ECG Heart Rhythms Explained - Comprehensive NCLEX Review, Simple Anatomy Quiz Most Nurses Get WRONG! Lesions of the plexus are asymmetric with sensorimotor involvement of multiple nerves in one extremity. On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. InMerriam-Webster.com dictionary. If you are under treatment with magnesium sulfate to prevent seizures, your healthcare provider may also test your reflexes to monitor for the need to start, adjust or stop the magnesium treatment. With deep reflexes, an internal structure (i.e., a tendon) stretches and stimulates the receptors in the muscle group. Deep tendon reflexes, of which the knee-jerk is the best known, are spinal reflexes triggered by hitting certain tendons. If you have tried taking over-the-counter medication without relief, if the headache is very painful, you have light sensitivity, or if your headache is accompanied by vision changes (please read the section below on "Changes in Vision") call your provider immediately and ask to see him/her that day. When these reflexes are disrupted, hyperreflexia (disease induced) or. And even if it's not a symptom of preeclampsia, it can still be a sign of a problem. Avoid excessive salt. The rooting reflex is present if stroking the lateral upper lip causes movement of the mouth toward the stimulus. This limits their sensitivity in detecting neuropathies of the small nerve fibers (i.e., those with pain, temperature, and autonomic functions). Increased peripheral vascular resistance and pulmonary edema may occur. In: StatPearls [Internet]. A symptom is something you may experience and recognize, such as a headache or loss of vision. Significant health history prior to pregnancy: Having more than one baby (twin, triplets etc. Is a change in your deep tendon reflex history an ominous sign? The .gov means its official. If you experience any of these changes in vision, you should contact your healthcare provider immediately or go directly to the hospital. Signs of shock with progression: Rapid shallow respirations, rapid pulse, fall in BP, skin pale and cool, decreased urinary output, changes in level of consciousness, laboratory signs-decreased platelets, prolonged prothrombin time, bleeding time prolonged, increased fibrin split products, decreased fibrinogen, Life threatening defect in coagulation that may occur w/ severe preeclampsia or eclampsia Preeclampsia can stress fetus. For women with mild preeclampsia, delivery is generally not indicated until 37 to 38 weeks of gestation and should occur by 40 weeks. It is a neurological condition that affects the nerve cells that control muscle movements. Clonus reflex is a set of rhythmic, involuntary muscle movements. Hyporeflexia is an absent or diminished response to tapping. An accurate weight is vital for a proper diagnosis. Biceps Reflex Muscle involved: biceps brachii Nerve supply: musculocutaneous Segmental innervation: C5-C6 Brachioradialis Reflex Muscle involved: brachioradialis Nerve supply: radial Segmental innervation: C5-C6 Triceps Reflex At 15 mEq/L, signs of abnormal conductivity surface as SA/AV node block. The benefit of aspirin is greatest (NNT = 19) for prevention of preeclampsia in women at highest risk (previous severe preeclampsia, diabetes, chronic hypertension, renal disease, or autoimmune disease). Two functions they perform: Give tone to the vessels (contraction and dilation of the vessel) and have a role with vessel permeability. Minimize stimulation: low lights, noise, activity to decrease probability of seizures The spiral arteries of the uterus play an important role in providing blood flow to the growing placenta and baby. RECAP: Youre assessing for new onset of hypertension (>140/90most likely to start occurring at 20 weeks and onward), protein in the urine proteinuria, signs and symptoms of organ injury. Blood pressure should be measured at each prenatal visit with an appropriately sized cuff and the patient in a seated position.28,29 Diagnostic criteria for preeclampsia are systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more on two occasions at least six hours apart.12,28,29 An increase of 30 mm Hg systolic or 15 mm Hg diastolic from baseline is no longer diagnostic for preeclampsia12 because similar increases are common in uncomplicated pregnancies. Fifty percent of women diagnosed with gestational hypertension between 24 and 35 weeks develop preeclampsia.8 Expectant management of mild gestational hypertension can reduce the increased rate of cesarean delivery associated with the induction of nulliparous women who have an unripe cervix.9 Women who progress to severe gestational hypertension based on the degree of blood pressure elevation have worse perinatal outcomes than do women with mild preeclampsia, and require management similar to those with severe preeclampsia.10, Preeclampsia is a multiorgan disease process of unknown etiology11 characterized by the development of hypertension and proteinuria after 20 weeks of gestation. If this pain accompanies one or more of the other symptoms, you should call your health care provider immediately. Do not try to lose weight during pregnancy by restricting your diet. Your doctor or midwife has asked you to use telehealth for some of your check-ups. Keep the pt side-lying for better utero-placental blood flow and to prevent aspiration. Somatosens Mot Res. The term peripheral neuropathy is usually used to describe symmetric and universal damage to adjacent nerves. It is also influenced by the brai a very sensitive test, depends on how performed and your mental state at that time. Sural and superficial peroneal nerves are preferred for biopsy. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Monitor presence of headache, epigastric pain, edema Some peripheral nerves are wrapped in a myelin sheath generated by Schwann cells, whereas others are unmyelinated. Accessibility Determination of fetal lung maturity for delivery A DTR is a brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap by a finger or rubber hammer on the tendon of insertio Hyperreflexia refers to hyperactive or repeating (clonic) reflexes. The former is usually achieved by eliminating offending agents, such as toxins or medications; correcting a nutritional deficiency; or treating the underlying disease (e.g., corticosteroid therapy for immune-mediated neuropathy).8 These steps are important to halt the progression of neuropathy, and they may improve symptoms. The fetal heart rate was 132 beats per minute. It was the beginning of my last year of undergrad when I found out I was pregnant. For potential or actual medical emergencies, immediately call 911 or your local emergency service. (2016). For managing severe preeclampsia between 24 and 34 weeks of gestation, the data are insufficient to determine whether an interventionist approach (i.e., induction or cesarean delivery 12 to 24 hours after corticosteroid administration) is superior to expectant management. +4 Generalized massive edema that includes ascites (accumulation of fluid in peritoneal cavity), **preventable** can cause SZ*** Retrieved 19 March 2020, from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/01/gestational-hypertension-and-preeclampsia, Merriam-Webster. Some healthcare providers will recommend bed rest for you, even though evidence has not shown it to make a difference in outcomes. The height adjusted Treflex was abnormal in 25 (96%) cases, including 6 of 7 patients with brisk or normal reflexes on clinical testing. Though the Centers for Disease Control and Prevention (CDC) have recently lifted many of the recommended COVID restrictions, COVID-19 infection increases risk of developing life-threatening hypert Pregnancy is an ideal time to get familiar with your blood pressure. All of these pain symptoms may be a sign of HELLP Syndrome or a related problem in the liver. The timing of an eclamptic seizure can be antepartum (53 percent), intrapartum (19 percent), or postpartum (28 percent).51 Late postpartum (more than 48 hours after delivery) onset of eclampsia was traditionally thought to be rare; however, a study of 29 cases of postpartum eclampsia demonstrated that 79 percent occurred in the late post-partum period.43,52. Preeclampsia is the development of new-onset hypertension with proteinuria after 20 weeks of gestation. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Women in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine.7, Morbidity occurs primarily from superimposed preeclampsia or IUGR.4 A sudden increase in blood pressure, new proteinuria, or signs and symptoms of severe preeclampsia indicate superimposed preeclampsia. Edema monitoring (watch for and educate mother about this): Calcium gluconate: antidote for magnesium sulfate toxicitybe sure to have it handy, Left side-lying position (helps prevent placenta ischemia and increases blood flow to baby), bed rest/limit stimulation, fetal heart rate monitoring (report decrease in fetal activity), Assess for seizure activity eclampsia: there is a risk during and after labor (up to 48 hours), Magnesium sulfate administered to prevent seizures during and after labor (risk for seizures up to 48 hours after delivery), Protein-rich diet (remember there may be low protein in blood due to proteinuriaprotein leaks into the urine and leaves blood), I & Os: strict monitoring (may need Foley catheter), abnormal sign: low urinary output less than 30 cc/hr (kidneys arent being perfused very well), Antihypertensives (labetalol, hydralazine), Test your knowledge: Preeclampsia NCLEX Questions, Gestational Hypertension and Preeclampsia. At every prenatal visit a woman will have her urine assessed for protein and glucose (glucose measurement is important for detecting gestational diabetes). Some primitive reflexes such as the asymmetric tonic neck reflex (ATNR) persist and he has increased muscle tone, especially in his legs. Aqu encontrar todo lo que necesita saber sobre cmo tomarse la presin arterial en casa. Monitor BP The grasp reflex is present if gently stroking the palm of the patient's hand causes the fingers to flex and grasp the examiner's . +2 Marked edema of lower extremities Monitor urine output closely: concerned if <30cc/hr, Foley, I+0 A deep tendon reflex reflects the function of a part of the nervous system that travels to and from the spinal cord. It tends to occur after 20 weeks of gestation, which is the halfway point of a typical 40 week pregnancy. We will discuss more about this in the pathophysiology section, which will correlate with the signs and symptoms you will see in the patient. PG, Tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord A postictal phase may follow with confusion, agitation, and combativeness. This is where we start to see the signs and symptoms of preeclampsia (they really stem from the damaged endothelial cells). official website and that any information you provide is encrypted Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Clinical signs may be a better indicator than serum levels of tissue levels of magnesium. Monitor maternal serum magnesium levels (therapeutic levels 4-8 mg/dl) People's deep tendon reflexes are widely variable. These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways. Treatment of peripheral neuropathy has two goals: controlling the underlying disease process and treating troublesome symptoms. Normal adult values: 1.7-2.4: Therapeutic range: 5-9: Loss of patellar reflexes . Copyright 2023 RegisteredNurseRN.com. Would you like email updates of new search results? Tiny clots form in the tiny blood vessels blocking blood flow to the organs and causing ischemia It is important to help patients control troublesome symptoms of peripheral neuropathy, such as severe numbness and pain, as well as to alleviate disability resulting from weakness.12 Several pharmacologic options exist to treat neuropathic pain, including some antiseizure medications (e.g., gabapentin [Neurontin], topiramate [Topamax], carbamazepine [Tegretol], pregabalin [Lyrica])13,14 and antidepressants (e.g., amitriptyline).1517 Topical patches and sprays containing lidocaine (Lidoderm) or capsaicin (Zostrix) also may relieve pain in some patients.18 Other supportive measures, such as foot care, weight reduction, and shoe selection, may also be helpful.2 Narcotics may have a role in the treatment of chronic neuropathic pain in selected patients19; candidates initially should be evaluated for their risk of substance abuse and addiction, and several nonnarcotic regimens should be tried first. Please note that home monitors are not always as accurate as those used in clinics or hospitals. +3 Edema of lower extremities, face, hands and sacral area Theyre both considered hypertensive disorders BUT gestational hypertension doesnt cause injury to organs in the body or proteinuria, and this leads us to the next criteria. . By using our website, you consent to our use of cookies. If the swelling in your hands and feet becomes severe, you may notice pitting edema (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs. Lower back pain is a very common complaint of pregnancy. These cells can be found lining the inside of blood vessels throughout the body and organs. HELLP Syndrome: hemolysis (rupture of RBCs), elevated liver enzymes, low platelets. Bookshelf Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. Triceps, biceps, patellar (k Dr. Bennett Machanic and another doctor agree. Normal pregnancy: vascular volume and cardiac output increase significantly, Kidneys: reduced renal bld flow: glomerular damage, loss of protein from kidneys causes edema and increased viscosity of the bld (rise in hematocrit), Preeclampsia in previous pregnancy or family history, Magnesium sulfate: Drug of choice to prevent eclamptic seizures, may have a secondary effect of dec. BP, but that is not the main action, Nursing care: Maintain a safe environment: padded side rails A 128-Hz tuning fork should be used to test the vibratory sensations in extremities. All Rights Reserved. Therefore, eclampsia causes seizure activity, which can lead to coma and death. Bethesda, MD 20894, Web Policies Headaches Blurry vision Change in behavior Fatigue Change in balance or coordination Numbness or tingling in the arms or legs Decrease in movement of the arms or legs Injury to the head, neck, or back Temperature of unknown source Seizures Slurred speech Weakness Tremor What is done during a neurological exam? Like headache and visual changes, hyperreflexia may indicate changes in your nervous system. La preeclampsia, en todas sus formas, puede requerir muchos anlisis, tanto durante como despus del embarazo. Additionally, patients begin to experience respiratory paralysis. By convention the deep tendon reflexes are graded as follows: 0 = no response; Dtr or deep tendon reflex is a test done on physical exam to evaluate specific nerve function. Question: Progesterone supplementation - first trimester and beyond - can it help the vascular constriction by keeping the smooth muscle relaxed (17HP shots), and is it associated with early supplemen On April 16, a briefing for U.S. Congressional staff offered insights about how maternity care is being provided in the midst of the COVID pandemic. Whether magnesium is given to prevent seizures or for tocolysis . Doppler flow studies to measure umbilical blood flow Report all medications prescribed by other doctors to your prenatal care provider so that these products can be checked regarding their safe use during pregnancy. No, there must be, History of preeclampsia in previous pregnancy or family history. Preeclamptic women were recorded during pregnancy and postpartum. Assessment prior to initiation: Vital signs, deep tendon reflexes/clonus, level of consciousness, symptoms such . Paraneoplastic panel (anti-Hu, anti-Yo, anti-Ri, anti-Tr, anti-Ma, and anti-CV2 antibodies), Mainly demyelinating, especially in viral hepatitis, Hepatic transaminase, bilirubin, albumin, and alkaline phosphatase levels, Fasting blood glucose level, glucose tolerance test, A1C level, Serum creatinine and blood urea nitrogen levels, Usually acute or subacute, but can be chronic, Phenolic glycolipid-1 antibody, skin biopsy, Urine and serum protein electrophoresis with immunofixation, Axonal damage predominates after treatment, Monoclonal gammopathy of undetermined significance, Rapid plasma reagin, VDRL, cerebrospinal fluid analysis, Peripheral neuropathy is intermixed with upper motor neuron signs, Neuropathy with liability to pressure palsies, Heavy metals (e.g., arsenic, lead, mercury, gold), Lead and mercury mainly cause motor neuropathy, 24-hour urine collection for heavy metal titers, Urinalysis (including 24-hour urine collection), Heavy metal toxicity, porphyrias, multiple myeloma, Antimyelin-associated glycoprotein and antiganglioside antibodies, Salivary flow rate, Schirmer test, rose bengal test, labial gland biopsy, Acute or chronic inflammatory demyelinating neuropathy. If you are concerned, or have had preeclampsia before, you can buy reagent strips at some pharmacies or online. HELLP (i.e., hemolysis, elevated liver enzymes, and low platelet count) syndrome is a form of severe preeclampsia with high rates of neonatal and maternal morbidity. Onset after 20 th week of pregnancy, may appear in labor or up to 48hours post partum. However, its important to note that this condition can present during the postpartum period (this is after delivery of the baby). The deep tendon reflexes were normal. It is our collective voice that reduces isolation for others, raises awareness and improves healthcare practices. This Physician Locator may help. The snout reflex is present if tapping a tongue blade across the lips causes pursing of the lips. What is normal for deep tendon reflexes? Loss of touch sensitivity in your fingers or toes. Copyright 1990, Butterworth Publishers, a division of Reed Publishing. The most common treatable causes are diabetes, hypothyroidism, and nutritional deficiencies. That means using your smart phone camera or just a reg A new study recently published by the New England Journal of Medicine found that women at high risk for preterm preeclampsia who took aspirin were less likely to develop the condition than women who w What is AFLP? Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia. 2022 Sep 11. Careers. A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria, though other methods may be used in clinics and medical offices such as a Protein:Creatinine Ratio (PCR) or a timed urine collection. His height and weight are both between the 25 to 50th percentiles and his head circumference is within 2 standard deviations of the mean.
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