Care Of The Patient With A Stroke

Download Care Of The Patient With A Stroke full books in PDF, epub, and Kindle. Read online Care Of The Patient With A Stroke ebook anywhere anytime directly on your device. Fast Download speed and no annoying ads. We cannot guarantee that every ebooks is available!

Acute Stroke Nursing

Author : Jane Williams
Publisher : John Wiley & Sons
ISBN 13 : 1118699629
Total Pages : 367 pages
Book Rating : 4.1/5 (186 download)

DOWNLOAD NOW!

Book Synopsis Acute Stroke Nursing by : Jane Williams

Download or read book Acute Stroke Nursing written by Jane Williams and published by John Wiley & Sons. This book was released on 2013-05-07 with total page 367 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases. This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team. Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing. Evidence-based and practical in style, with case studies and practice examples throughout Edited and authored by recognised stroke nursing experts, clinicians and leaders in the field of nursing practice, research and education The first text to explore stroke management from UK and international perspectives, and with a nursing focus

Critical Care of the Stroke Patient

Author : Stefan Schwab
Publisher : Cambridge University Press
ISBN 13 : 1139991558
Total Pages : 579 pages
Book Rating : 4.1/5 (399 download)

DOWNLOAD NOW!

Book Synopsis Critical Care of the Stroke Patient by : Stefan Schwab

Download or read book Critical Care of the Stroke Patient written by Stefan Schwab and published by Cambridge University Press. This book was released on 2014-06-05 with total page 579 pages. Available in PDF, EPUB and Kindle. Book excerpt: New and groundbreaking therapeutic options for the critical care of patients with cerebrovascular disease have improved patient management, minimized morbidity, reduced in-patient care, improved quality of life, and had a positive economic impact on health service provision. This volume integrates these approaches and suggests the best therapy option for all cerebrovascular conditions. The early chapters of the book focus on monitoring techniques and interventions. Subsequent sections address the critical care of a wide range of cerebrovascular diseases: ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, arteriovenous malformations, cerebral venous thrombosis and traumatic injury. The editors and authors are internationally recognized experts in their field, and the text is supplemented by tables and illustrations to demonstrate important clinical findings. This book will meet the needs of stroke physicians, neurologists, neurosurgeons, neurointensivists and interventional neuroradiologists seeking to maximize positive outcomes for their patients.

The Stroke Book

Author : Michel T. Torbey
Publisher : Cambridge University Press
ISBN 13 : 1107634725
Total Pages : 395 pages
Book Rating : 4.1/5 (76 download)

DOWNLOAD NOW!

Book Synopsis The Stroke Book by : Michel T. Torbey

Download or read book The Stroke Book written by Michel T. Torbey and published by Cambridge University Press. This book was released on 2013-07-18 with total page 395 pages. Available in PDF, EPUB and Kindle. Book excerpt: An essential companion for busy professionals seeking to navigate stroke-related clinical situations successfully and make quick informed treatment decisions.

Care of the Patient with a Stroke

Author : Genevieve Waples Smith
Publisher : Springer
ISBN 13 : 3662382806
Total Pages : 158 pages
Book Rating : 4.6/5 (623 download)

DOWNLOAD NOW!

Book Synopsis Care of the Patient with a Stroke by : Genevieve Waples Smith

Download or read book Care of the Patient with a Stroke written by Genevieve Waples Smith and published by Springer. This book was released on 2013-12-11 with total page 158 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Fast Facts for Stroke Care Nursing

Author : Kathy Morrison
Publisher : Springer Publishing Company
ISBN 13 : 0826127177
Total Pages : 233 pages
Book Rating : 4.8/5 (261 download)

DOWNLOAD NOW!

Book Synopsis Fast Facts for Stroke Care Nursing by : Kathy Morrison

Download or read book Fast Facts for Stroke Care Nursing written by Kathy Morrison and published by Springer Publishing Company. This book was released on 2014-05-07 with total page 233 pages. Available in PDF, EPUB and Kindle. Book excerpt: "[P]rovides a succinct yet comprehensive review of the evolution of stroke patient management. The text starts with a brief overview of the anatomy and physiology, tying it to the types of strokes, the assessment, and diagnostic tools. Acute measures and prevention of secondary injury are outlined and lead us to review the potential complications and finally the rehabilitation and patient/family education. Particularly helpful is the inclusion of the Brain Attack Coalition, The Joint Commission, and Centers for Medicare & Medicaid Services core measuresÖ.[The author] has done an excellent job of keeping this book appropriate for everyday use." óFrom the Foreword Linda Littlejohns, MSN, RN, FAAN, CNRN The best aspects of the book are that it is easy to read and factual, and it includes a wide range of information... I enjoyed the book. It is easy to read and navigate. Nurses will find it extremely helpful and valuable in the clinical setting. This is a good addition to a clinical library." Score: 98, 5 Stars.--Doody's Medical Reviews This highly practical, pocket-sized reference for stroke care nurses provides quick, bedside access to the most current guidelines for diagnostic tests, state-of-the-art treatments, and best-practice standards. This resource distills lengthy and often complex national stroke care guidelines into clear, bite-size pieces of information. It also explains the rationale behind stroke standards, making them easier to embrace and incorporate into practice. The book is organized consistently to foster rapid information retrieval. Each chapter includes objectives and such helpful features as "Fast Facts in a Nutshell," targeted segments that provide critical information at a glance. The guide also serves as an instructive resource for nurses not specializing in neurology but who are increasingly being called on to care for stroke patients. The book is also a helpful resource for stroke program coordinators and as a review for SCRN and CNRN certification exams. Key Features: Reflects current standards of the American Heart Association, the American Stroke Association, and The Joint Commission Provides crucial information at a glance about diagnostic tests, state-of-the-art treatments, and best-practice standards Distills lengthy and complex national stroke care standards into clear, concise information Includes a comprehensive review of diagnostic studies Serves as a concise review for SCRN and CNRN certification exams

The Continuum of Stroke Care

Author : Joanne V. Hickey
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 1496317564
Total Pages : 452 pages
Book Rating : 4.4/5 (963 download)

DOWNLOAD NOW!

Book Synopsis The Continuum of Stroke Care by : Joanne V. Hickey

Download or read book The Continuum of Stroke Care written by Joanne V. Hickey and published by Lippincott Williams & Wilkins. This book was released on 2015-03-25 with total page 452 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Continuum of Stroke Care: An Interprofessional Approach to Evidence-Based Care will address the clinical care of stroke patients across the continuum of care from primary prevention of stroke, the acute and subacute treatment of stroke syndromes through rehabilitation, and reintegration into the community. Each chapter will review current evidence-based practice guiding clinical stroke care. The book will address the American Stroke Association’s Stroke Chain of Survival addressing prehospital care of the stroke patient and the development of stroke systems of care to provide all people in the United States access to acute stroke care. Additionally, the book will cover the current role of state legislation in stroke care and the evolution of hospital stroke certification. The book will serve as a clinical resource providing detailed comprehensive medical and nursing care of all stroke subtypes while also addressing the system of stroke care in which medical, nursing and interprofessional care provided. As such, the book will serve as a clinical resource to medical and nursing caregivers providing direct patient care as well as stroke coordinators, program directors and other hospital administrators developing stroke programs. The book will also be a clinical resource for stroke interprofessional team members such as physical therapists, occupational therapists, Stroke care is most successful at improving patient outcomes when delivered by an interdisciplinary team. Each chapter will address the critical role of the interprofessional team and highlight comprehensive care of the stroke patient rather than focusing only on nursing care. Books published to date focus solely on the medical or nursing care of the stroke patient without attention to the stroke system of care and the role of the multidisciplinary team in improving stroke outcomes. Additionally, each chapter will highlight ongoing research trials and opportunities, with the recognition that the scientific foundation for acute stroke care is rapidly evolving.

Disease Control Priorities, Third Edition (Volume 5)

Author : Dorairaj Prabhakaran
Publisher : World Bank Publications
ISBN 13 : 1464805202
Total Pages : 466 pages
Book Rating : 4.4/5 (648 download)

DOWNLOAD NOW!

Book Synopsis Disease Control Priorities, Third Edition (Volume 5) by : Dorairaj Prabhakaran

Download or read book Disease Control Priorities, Third Edition (Volume 5) written by Dorairaj Prabhakaran and published by World Bank Publications. This book was released on 2017-11-17 with total page 466 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular, respiratory, and related conditions cause more than 40 percent of all deaths globally, and their substantial burden is rising, particularly in low- and middle-income countries (LMICs). Their burden extends well beyond health effects to include significant economic and societal consequences. Most of these conditions are related, share risk factors, and have common control measures at the clinical, population, and policy levels. Lives can be extended and improved when these diseases are prevented, detected, and managed. This volume summarizes current knowledge and presents evidence-based interventions that are effective, cost-effective, and scalable in LMICs.

Care of the Patient with a Stroke

Author : Genevieve Waples Smith
Publisher :
ISBN 13 :
Total Pages : 148 pages
Book Rating : 4.:/5 (47 download)

DOWNLOAD NOW!

Book Synopsis Care of the Patient with a Stroke by : Genevieve Waples Smith

Download or read book Care of the Patient with a Stroke written by Genevieve Waples Smith and published by . This book was released on 1959 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Acute Ischemic Stroke

Author : R. Gilberto González
Publisher : Springer Science & Business Media
ISBN 13 : 3642127517
Total Pages : 299 pages
Book Rating : 4.6/5 (421 download)

DOWNLOAD NOW!

Book Synopsis Acute Ischemic Stroke by : R. Gilberto González

Download or read book Acute Ischemic Stroke written by R. Gilberto González and published by Springer Science & Business Media. This book was released on 2010-10-05 with total page 299 pages. Available in PDF, EPUB and Kindle. Book excerpt: This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.

Clinical Pathways in Stroke Rehabilitation

Author : Thomas Platz
Publisher : Springer Nature
ISBN 13 : 3030585050
Total Pages : 284 pages
Book Rating : 4.0/5 (35 download)

DOWNLOAD NOW!

Book Synopsis Clinical Pathways in Stroke Rehabilitation by : Thomas Platz

Download or read book Clinical Pathways in Stroke Rehabilitation written by Thomas Platz and published by Springer Nature. This book was released on 2021-01-14 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives.

Cerebral Small Vessel Disease

Author : Leonardo Pantoni
Publisher : Cambridge University Press
ISBN 13 : 1107031664
Total Pages : 375 pages
Book Rating : 4.1/5 (7 download)

DOWNLOAD NOW!

Book Synopsis Cerebral Small Vessel Disease by : Leonardo Pantoni

Download or read book Cerebral Small Vessel Disease written by Leonardo Pantoni and published by Cambridge University Press. This book was released on 2014-05 with total page 375 pages. Available in PDF, EPUB and Kindle. Book excerpt: Up-to-date discussion of the etiology, diagnosis, treatment, and prevention of this common cause of stroke and cognitive impairment.

Care of the Patient with a Stroke

Author : Genevieve W. Smith
Publisher :
ISBN 13 :
Total Pages : 170 pages
Book Rating : 4.:/5 (5 download)

DOWNLOAD NOW!

Book Synopsis Care of the Patient with a Stroke by : Genevieve W. Smith

Download or read book Care of the Patient with a Stroke written by Genevieve W. Smith and published by . This book was released on 1959 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Fast Facts for Stroke Care Nursing

Author : Kathy J. Morrison, MSN, RN, CNRN, SCRN
Publisher : Springer Publishing Company
ISBN 13 : 0826127185
Total Pages : 232 pages
Book Rating : 4.8/5 (261 download)

DOWNLOAD NOW!

Book Synopsis Fast Facts for Stroke Care Nursing by : Kathy J. Morrison, MSN, RN, CNRN, SCRN

Download or read book Fast Facts for Stroke Care Nursing written by Kathy J. Morrison, MSN, RN, CNRN, SCRN and published by Springer Publishing Company. This book was released on 2014-05-07 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: ì[P]rovides a succinct yet comprehensive review of the evolution of stroke patient management. The text starts with a brief overview of the anatomy and physiology, tying it to the types of strokes, the assessment, and diagnostic tools. Acute measures and prevention of secondary injury are outlined and lead us to review the potential complications and finally the rehabilitation and patient/family education. Particularly helpful is the inclusion of the Brain Attack Coalition, The Joint Commission, and Centers for Medicare & Medicaid Services core measuresÖ.[The author] has done an excellent job of keeping this book appropriate for everyday use.î óFrom the Foreword Linda Littlejohns, MSN, RN, FAAN, CNRN "The best aspects of the book are that it is easy to read and factual, and it includes a wide range of information... I enjoyed the book. It is easy to read and navigate. Nurses will find it extremely helpful and valuable in the clinical setting. This is a good addition to a clinical library." Score: 98, 5 Stars.--Doody's Medical Reviews This highly practical, pocket-sized reference for stroke care nurses provides quick, bedside access to the most current guidelines for diagnostic tests, state-of-the-art treatments, and best-practice standards. This resource distills lengthy and often complex national stroke care guidelines into clear, bite-size pieces of information. It also explains the rationale behind stroke standards, making them easier to embrace and incorporate into practice. The book is organized consistently to foster rapid information retrieval. Each chapter includes objectives and such helpful features as ìFast Facts in a Nutshell,î targeted segments that provide critical information at a glance. The guide also serves as an instructive resource for nurses not specializing in neurology but who are increasingly being called on to care for stroke patients. The book is also a helpful resource for stroke program coordinators and as a review for SCRN and CNRN certification exams. Key Features: Reflects current standards of the American Heart Association, the American Stroke Association, and The Joint Commission Provides crucial information at a glance about diagnostic tests, state-of-the-art treatments, and best-practice standards Distills lengthy and complex national stroke care standards into clear, concise information Includes a comprehensive review of diagnostic studies Serves as a concise review for SCRN and CNRN certification exams

Fast Facts for Stroke Care Nursing, Second Edition

Author : Kathy J. Morrison, MSN, RN, CNRN, SCRN
Publisher : Springer Publishing Company
ISBN 13 : 0826158315
Total Pages : 235 pages
Book Rating : 4.8/5 (261 download)

DOWNLOAD NOW!

Book Synopsis Fast Facts for Stroke Care Nursing, Second Edition by : Kathy J. Morrison, MSN, RN, CNRN, SCRN

Download or read book Fast Facts for Stroke Care Nursing, Second Edition written by Kathy J. Morrison, MSN, RN, CNRN, SCRN and published by Springer Publishing Company. This book was released on 2018-06-28 with total page 235 pages. Available in PDF, EPUB and Kindle. Book excerpt: “[This] quick reference text to guide nurses is a ‘must-have’ as this disease tests our health care delivery system... Fast Facts for Stroke Care Nursing, Second Edition provides a succinct yet comprehensive review.” --Linda Littlejohns, MSN, RN, FAAN, SCRN, CNRN Neuroscience Clinical Nurse Consultant From the Foreword The second edition of this practical, pocket-sized reference has been updated to include the groundbreaking changes to stroke care protocols. Stroke is the fifth leading cause of death in the United States today and leading preventable cause of long-term disability. This resource fills in the gaps left in neuroscience content in nursing school and streamlines an often intimidating, but critically important, area of care. Featuring diagnostic tests, cutting-edge treatments, and standards for best practice, Fast Facts for Stroke Care Nursing, Second Edition distills the lengthy and often complex national stroke care guidelines into a clear, easily digestible format. This guide can be used as a staff education resource or as a concise review for SCRN or SNRN certification exams, as well as a refresher for nurses seeking the essentials of stroke care. Content starts with stroke care improvements, covers moving through acute care to postacute care, and finishes with practical pointers for performance improvement. New to the Second Edition: Updated diagnostics with additional MR, CT, and transcranial Doppler options Modified Rankin Scale score Expands upon the neurological assessment with tips for completing it New acute hemorrhagic stroke intervention and 2015 landmark studies on thrombectomy Pipeline device New large-vessel occlusion tools, routing plans, and certification programs for prehospital personnel Expanded use of telemedicine Information for advanced practice providers Changes to the prehospital phase, the acute treatment phase, and the population affected by stroke Key Features: Reflects current standards of the American Heart Association, American Stroke Association, and The Joint Commission Provides crucial information at a glance about diagnostic tests, state-of-the-art treatments, and best practice standards

Stroke

Author : Msn Rn Riske
Publisher :
ISBN 13 : 9780998111407
Total Pages : pages
Book Rating : 4.1/5 (114 download)

DOWNLOAD NOW!

Book Synopsis Stroke by : Msn Rn Riske

Download or read book Stroke written by Msn Rn Riske and published by . This book was released on 2016-09-15 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Do you find it scary and overwhelming to take care of someone who has suffered a brain injury? Caring for a patient who has had a stroke can be very challenging. Trust us, we have been right where you are and we know the intimidation you might feel when thinking of all the components of caring for patients with this complex diagnosis. Nursing assessment is a crucial piece of the overall puzzle that will determine how the patient is cared for and, ultimately, the outcome of the patient. From the moment a patient arrives to the hospital with stroke-like symptoms, all members of the stroke care team begin working on the patient's history, obtaining tests, drawing labs, developing a plan, implementing safety measures, carrying out time-sensitive orders, and educating the patient and the patient's family. This book is a guide for anyone new to caring for stroke patients in the hospital setting. We have used our own nursing and teaching experience to help explain how to assess, anticipate, and prevent complications, and what to expect while caring for anyone who has been admitted to the hospital for a stroke or stroke-like symptoms. Our hope is that you feel more confident while caring for and educating this patient population. Table of Contents Chapter 1: Anatomy and Physiology Parts of the Brain Blood Supply Risk Factors Transient Ischemic Attack (TIA) Ischemic Stroke Hemorrhagic Stroke Chapter 2: Assessment Common Stroke Symptoms Components of a Neurological Assessment NIH Stroke Scale Chapter 3: Orders Emergency Department Orders General Stroke Orders Ischemic Stroke Orders Hemorrhagic Stroke Orders Chapter 4: Complications Cerebral Edema and Herniation Hemorrhagic Conversion Seizures Chapter 5: Nursing Care and Considerations Time Is Brain Impaired Communication Swallow Precautions Bowel and Bladder Issues Mobility Fall Prevention Pain Management Emotional Support Discharge Planning Chapter 6: Critical Care and Interventions Ventriculostomy (Ventric) and External Ventricular Drains (EVD) Intracranial Pressure Monitoring Tissue Plasminogen Activator (tPA) Intraarterial tPA Craniotomy (Crani) Aneurysm Clipping Craniectomy Neurovascular Interventions Chapter 7: Case Studies Case Study 1, 2, 3, 4

Stroke Certification Study Guide for Nurses

Author : Kathy J. Morrison, MSN, RN, CNRN, SCRN, FAHA
Publisher : Springer Publishing Company
ISBN 13 : 0826119662
Total Pages : 175 pages
Book Rating : 4.8/5 (261 download)

DOWNLOAD NOW!

Book Synopsis Stroke Certification Study Guide for Nurses by : Kathy J. Morrison, MSN, RN, CNRN, SCRN, FAHA

Download or read book Stroke Certification Study Guide for Nurses written by Kathy J. Morrison, MSN, RN, CNRN, SCRN, FAHA and published by Springer Publishing Company. This book was released on 2017-07-28 with total page 175 pages. Available in PDF, EPUB and Kindle. Book excerpt: Print version of the book includes free access to the app (web, iOS, and Android), which offers interactive Q&A review plus the entire text of the print book! Please note the app is included with print purchase only. Promotes optimal test performance! This sought-after companion to the author’s popular Fast Facts for Stroke Care Nursing is a must-have study guide for nurses seeking Stroke Certified Registered Nurse (SCRN®) status. It contains comprehensive information about the exam, answers to commonly asked questions, and savvy tips for maximizing your score, along with 300 practice questions and answers with rationales. Designed to prepare nurses for the multiple-choice format of the certification exam, questions are arranged in chapters correlating with the logical sequence and flow of the exam and reflect the number of questions in each exam category. Case studies facilitate the application of knowledge with various examples of common stroke patient situations. A complete practice exam with answers and detailed rationales enables stroke care nurses and advanced practice clinicians to ascertain their strengths and weaknesses. Appendices include a list of medications, national stroke guidelines, and neuroscience terms. Key Features: Promotes comprehensive and rigorous study for the SCRN exam Helps stroke care nurses and advanced practice clinicians maximize their scores Contains 300 exam-style questions with correct answers and detailed rationales along with a complete practice exam Includes important information about the exam itself, answers to commonly asked questions, and case studies Covers content in accordance with the test blueprint of the SCRN exam

Telestroke: the Use of Telemedicine in Stroke Care

Author : Thierry Moulin
Publisher :
ISBN 13 : 9783805591553
Total Pages : 0 pages
Book Rating : 4.5/5 (915 download)

DOWNLOAD NOW!

Book Synopsis Telestroke: the Use of Telemedicine in Stroke Care by : Thierry Moulin

Download or read book Telestroke: the Use of Telemedicine in Stroke Care written by Thierry Moulin and published by . This book was released on 2009 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This issue is a dedicated supplement published in addition to the regular issues of 'Cerebrovascular Diseases' focussing on one specific topic. 'Cerebrovascular Diseases' is a well-respected, international peer-reviewed journal in Neurology. Supplement issues are included in the subscription.