Stroke Ischemic
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Stroke Ischemic as PDF for free.
More details
- Words: 2,132
- Pages: 3
Print Only Selected Items
PHYSICIAN'S ORDER SHEET Stroke – ischemic Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
Print All
patient imprint
Allergies:_______________ Admission Status g Admit to inpatient to Dr. ______service. c d e f c Admit to observation to Dr. _________ service. d e f g Admit Location c Admit to location __________________ d e f g
Code Status g Resuscitation status Full Code c d e f c Resuscitation status Do Not Resuscitate / Do Not d e f g Intubate (allow natural death) c Resuscitation status Partial Code d e f g
Vital Signs g Vitals per unit protocol c d e f c Vital signs every______hours and then d e f g _____________ Pulse oximetry c Continuous d e f g c Spot q shift and prn d e f g
Activity g Ambulate with assistance. c d e f c Bed rest / bed rest with bedside commode d e f g c Up ad lib d e f g
Nursing Orders Assessments b Stand Dysphagia Protocol/Bedside swallowing c d e f g evaluation Evidence c Glucose, blood, fingerstick. _______ One Time. Other d e f g Frequency _______________ If blood glucose greater than or equal to ____, intiate glycemic control protocol. g Measure and document intake and output Total for c d e f every 8 hours c Measure weight d e f g Contingency c Notify provider specify parameters temp > 101; HR < d e f g 60 or > 120, RR < 8 or > 30, SBP < 90 or > 180; UO < 120 in 4 hours, or deterioration in neurologic status. Interventions c Elevate head of bed to ___ degrees. d e f g c Urinary catheter initiation/management d e f g c Urinary straight catheterization d e f g c Nasogastric/orogastric tube insertion/management d e f g Respiratory c Oxygen via __________@ _____ to maintain O2 sat at d e f g 90% or greater. c Biphasic positive airway pressure (BIPAP) d e f g c Continuous positive airway pressure (CPAP) d e f g
g Blood gas, arterial now if not done and ________. c d e f c Blood gas, venous now if not done and ________. d e f g Source c Pulmonary Function Testing d e f g c FVC/negative inspiratory force every 6 hours d e f g c Ventilator settings d e f g
Diet g NPO / NPO except po meds with sips. c d e f c Clear liquids d e f g c Regular diet d e f g c Therapeutic diet ____________. d e f g IV Fluids c Sodium Chloride 0.9% @ ______mL/hr for 24 hours. d e f g c Additives ______________________ d e f g c Saline lock. d e f g
Medications Reminders Avoid sublingual NIFEdipine Evidence Avoid the routine use of a therapeutic dose of low molecularweight heparin Evidence Avoid the routine use of a therapeutic dose of unfractionated heparin Evidence Evidence to support the routine use of colony stimulating factors is inconclusive Evidence Platelet Inhibitors Combination Agents Evidence Consider aspirindipyridamole within 48 hours of admission and upon discharge in patients who do not have an indication for warfarin c aspirindipyridamole/AGGRENOX 1 capsule, d e f g sustained release orally 2 times a day Salicylates Evidence Aspirin should be administered within 4 hours of admission and prescribed upon discharge to patients who do not have an indication for warfarin c aspirin 81 milligram orally once a day d e f g Thienopyridines Evidence A thienopyridine should be administered within 6 hours of admission and prescribed upon discharge to patients who do not have an indication for warfarin and who have a contraindication to aspirin, or have severe peripheral vascular disease or have underlying cardiac indication. c clopidogrel /PLAVIX 75 milligram orally once a day d e f g
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. In the absence of cardiac indications, it is Severe Pain (710) Evidence recommended that aspirin and clopidogrel not be Consider the use of an opioid analgesic; morphine at used in combination for stroke prevention, given the a dose of 0.1 mg/kg body weight has limited apparent lack of greater efficacy compared with effectiveness Evidence clopidogrel or aspirin alone and the substantially c HYDROmorphone /DILAUDID 1 milligram SC/IV d e f g increased risk of bleeding complications every __ 4 hrs. __ 6 hours as needed for pain c morphine ____ milligram intravenously every d e f g LipidRegulating Agents Evidence ____hours as needed for pain Reminders Patients with cerebrovascular disease in the presence c morphine ____mg intravenously every 5 minutes to d e f g a maximum of 10 mg/hr. of coronary heart disease or symptomatic Antidotes and Rescue Agents atherosclerotic disease should be treated with a 3 hydroxy3methylglutaryl coenzyme A reductase c naloxone /NARCAN ___ (0.42) milligram d e f g inhibitor to reduce lowdensity lipoprotein cholesterol intravenously every ____min. (23) as needed for levels to less than 100 mg/dL (less than 70 mg/dL for opiate reversal to improve mentation and RR > 10 veryhighrisk patients); secondary goals of therapy and notify physician STAT include normalizing triglycerides and reducing non– Antipyretics highdensity lipoprotein cholesterol levels to less than c acetaminophen /TYLENOL 650 milligram orally or d e f g rectally every 4 hours as needed for fever >100.4 130 mg/dL Evidence c acetaminophen /TYLENOL 650 milligram orally or d e f g HMGCoA Reductase Inhibitors rectally every 6 hours as needed for fever greater c atorvastatin /LIPITOR 10 milligram orally once a d e f g than 100.4 day in the evening Laxatives atorvastatin /LIPITOR 20 milligram orally once a c d e f g c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g day in the evening milliliter orally once a day as needed for constipation atorvastatin /LIPITOR 40 milligram orally once a c d e f g c docusate sodium /COLACE 100 milligram orally 2 d e f g day in the evening times a day c simvastatin /ZOCOR 20 milligram orally once a day, d e f g c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g in the evening needed for constipation c simvastatin /ZOCOR 40 milligram orally once a day, d e f g c bisacodyl /DULCOLAX 10 milligram suppository d e f g in the evening rectally once a day as needed for constipation Anticoagulants DVT Prophylaxis c warfarin/COUMADIN ____mg orally daily. d e f g Mechanical methods of prophylaxis should be used Analgesics primarily in patients who are at high risk of bleeding or Mild Pain (13) Evidence as an adjunct to anticoagulantbased prophylaxis. acetaminophen /TYLENOL ____650 mg ____650 mg c d e f g Consider renal impairment when deciding on doses of orally or rectally _____every 4 hours ____every 6 LMWH, the direct thrombin inhibitors, and other hours as needed for pain antithrombotic drugs that are cleared by the kidneys, c ibuprofen /MOTRIN 400 milligram orally every 4 d e f g particularly in elderly patients and those who are at high hours as needed for pain risk for bleeding. (Contraindicated in pregnant women and children < 6 In acutely ill medical patients who have been admitted mos. of age) to the hospital with CHF or severe respiratory disease, Moderate Pain (46) or who are confined to bed and have one or more c hydrocodone/APAP/LORTAB d e f g adtioanla risk factors, inclujding active CA, previous ____5/500_____7.5/500 ______10/500 tablet orally VTE, sepsis, acute neurologic disease, or inflammatory every ____4 hr._____6 hr. as needed for pain bowel disease, prophylaxis with LDUH or LMWH is c oxycodoneAPAP/PERCOCET d e f g recommended. In meidcal patients with risk factors for ____5/325______7.5/325_____10/325 tablet orally VTE in whom there is a contraindication to anticoagulant every _____4hr._____6hr. as needed for pain prophylaxis, GCS or IPC is recommended. c oxycodone _____mg tablet orally every d e f g c Early and persistant mobilization d e f g _____4hr._____6hr. as needed for pain c Graded compression stockings (1530 mm Hg of d e f g pressure at the ankle)
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. c Sequential Compression Device d e f g c CBC every other day starting on day 4 of heparin d e f g Other:______________________ therapy thru day 14 or until Unfractionated c MRA neck ___with __without contrast. Evidence d e f g heparin/LMWH is discontinued. c MRA brain __with contrast __without contrast Evidence d e f g LowDose Unfractionated Heparin c MRI, brain, without contrast Evidence d e f g c heparin 5,000 unit subcutaneously every 8 hours d e f g c MRI, brain, with contrast Evidence d e f g LowMolecularWeight Heparins c Ultrasound, carotid, Doppler, bilateral Evidence d e f g c enoxaparin /LOVENOX 40 milligram subcutaneously g d e f g c Interventional radiology, angiogram, aortic arch study d e f once a day with intracranial vessels Stress Ulcer Prophylaxis c Interventional radiology, angiogram, carotid, cerebral, d e f g c Initiate Stress Ulcer Prophylaxis Protocol d e f g bilateral Evidence Laboratory c Interventional radiology, angiogram, carotid, cerebral, d e f g b Complete blood cell count with automated white blood c d e f g left Evidence cell differential Evidence c Interventional radiology, angiogram, carotid, cerebral, d e f g b Erythrocyte sedimentation rate (ESR) c d e f g right Evidence b Partial thromboplastin time (PTT), activated c d e f g c Interventional radiology, angiogram, carotid, cervical, d e f g b Prothrombin time (PT) and international normalized ratio c d e f g bilateral Evidence (INR) Evidence Interventional radiology, angiogram, carotid, cervical, c d e f g c Basic metabolic panel d e f g left Evidence c Comprehensive metabolic panel d e f g c Interventional radiology, angiogram, carotid, cervical, d e f g b Lipid panel c d e f g c Magnesium (Mg) Evidence d e f g right Evidence c Phosphorus level Evidence d e f g c Interventional radiology, angiogram, intracranial d e f g c Creatine kinase, total (CKtotal) , CKMB isoenzyme, d e f g Evidence troponin Consults c Rapid plasma reagin (RPR), qualitative d e f g c Consult to cardiology Evidence d e f g b Urinalysis (UA) with microscopy c d e f g c Consult to dietitian, adult Evidence d e f g c Toxicology drug screen, urine d e f g c Consult to internal medicine d e f g c Hypercoagulopathy panel (protein C deficiency, protein S d e f g c Consult to Acute inpatient rehabilitation Evidence d e f deficiency, lupus anticoagulant, anticardolipin antibodies, g c Consult to neurology d e f g activated protein C resistance, factor V Leiden, c Consult to occupational therapy d e f g Prothrombin gene analysis) c Consult to Palliative Care d e f g Avoid the routine ordering of tests to identify coagulation c Consult to physical therapy d e f g defects (eg, protein C deficiency, protein S deficiency, lupus anticoagulant, anticardiolipin antibodies, activated c Consult to speech therapy d e f g protein C resistance/factor V Leiden mutation) Evidence c Consult to vascular surgery Evidence d e f g Diagnostic Tests b 12lead ECG Evidence c d e f g c Echocardiogram, transthoracic Evidence d e f g c Echocardiogram, transesophageal Evidence d e f g c Radiograph, chest, 1 view Evidence d e f g c Radiograph, chest, 2 views Evidence d e f g c Radiograph, swallowing function, with cineradiography d e f g and/or videoradiography (modified barium swallow) Evidence c CT, head or brain, without contrast on admission d e f g Evidence c CT Angiography of the head Evidence d e f g c CT Angiography of the neck. Evidence d e f g Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
Print Only Selected Items
Print All
PHYSICIAN'S ORDER SHEET Stroke – ischemic Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
Print All
patient imprint
Allergies:_______________ Admission Status g Admit to inpatient to Dr. ______service. c d e f c Admit to observation to Dr. _________ service. d e f g Admit Location c Admit to location __________________ d e f g
Code Status g Resuscitation status Full Code c d e f c Resuscitation status Do Not Resuscitate / Do Not d e f g Intubate (allow natural death) c Resuscitation status Partial Code d e f g
Vital Signs g Vitals per unit protocol c d e f c Vital signs every______hours and then d e f g _____________ Pulse oximetry c Continuous d e f g c Spot q shift and prn d e f g
Activity g Ambulate with assistance. c d e f c Bed rest / bed rest with bedside commode d e f g c Up ad lib d e f g
Nursing Orders Assessments b Stand Dysphagia Protocol/Bedside swallowing c d e f g evaluation Evidence c Glucose, blood, fingerstick. _______ One Time. Other d e f g Frequency _______________ If blood glucose greater than or equal to ____, intiate glycemic control protocol. g Measure and document intake and output Total for c d e f every 8 hours c Measure weight d e f g Contingency c Notify provider specify parameters temp > 101; HR < d e f g 60 or > 120, RR < 8 or > 30, SBP < 90 or > 180; UO < 120 in 4 hours, or deterioration in neurologic status. Interventions c Elevate head of bed to ___ degrees. d e f g c Urinary catheter initiation/management d e f g c Urinary straight catheterization d e f g c Nasogastric/orogastric tube insertion/management d e f g Respiratory c Oxygen via __________@ _____ to maintain O2 sat at d e f g 90% or greater. c Biphasic positive airway pressure (BIPAP) d e f g c Continuous positive airway pressure (CPAP) d e f g
g Blood gas, arterial now if not done and ________. c d e f c Blood gas, venous now if not done and ________. d e f g Source c Pulmonary Function Testing d e f g c FVC/negative inspiratory force every 6 hours d e f g c Ventilator settings d e f g
Diet g NPO / NPO except po meds with sips. c d e f c Clear liquids d e f g c Regular diet d e f g c Therapeutic diet ____________. d e f g IV Fluids c Sodium Chloride 0.9% @ ______mL/hr for 24 hours. d e f g c Additives ______________________ d e f g c Saline lock. d e f g
Medications Reminders Avoid sublingual NIFEdipine Evidence Avoid the routine use of a therapeutic dose of low molecularweight heparin Evidence Avoid the routine use of a therapeutic dose of unfractionated heparin Evidence Evidence to support the routine use of colony stimulating factors is inconclusive Evidence Platelet Inhibitors Combination Agents Evidence Consider aspirindipyridamole within 48 hours of admission and upon discharge in patients who do not have an indication for warfarin c aspirindipyridamole/AGGRENOX 1 capsule, d e f g sustained release orally 2 times a day Salicylates Evidence Aspirin should be administered within 4 hours of admission and prescribed upon discharge to patients who do not have an indication for warfarin c aspirin 81 milligram orally once a day d e f g Thienopyridines Evidence A thienopyridine should be administered within 6 hours of admission and prescribed upon discharge to patients who do not have an indication for warfarin and who have a contraindication to aspirin, or have severe peripheral vascular disease or have underlying cardiac indication. c clopidogrel /PLAVIX 75 milligram orally once a day d e f g
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. In the absence of cardiac indications, it is Severe Pain (710) Evidence recommended that aspirin and clopidogrel not be Consider the use of an opioid analgesic; morphine at used in combination for stroke prevention, given the a dose of 0.1 mg/kg body weight has limited apparent lack of greater efficacy compared with effectiveness Evidence clopidogrel or aspirin alone and the substantially c HYDROmorphone /DILAUDID 1 milligram SC/IV d e f g increased risk of bleeding complications every __ 4 hrs. __ 6 hours as needed for pain c morphine ____ milligram intravenously every d e f g LipidRegulating Agents Evidence ____hours as needed for pain Reminders Patients with cerebrovascular disease in the presence c morphine ____mg intravenously every 5 minutes to d e f g a maximum of 10 mg/hr. of coronary heart disease or symptomatic Antidotes and Rescue Agents atherosclerotic disease should be treated with a 3 hydroxy3methylglutaryl coenzyme A reductase c naloxone /NARCAN ___ (0.42) milligram d e f g inhibitor to reduce lowdensity lipoprotein cholesterol intravenously every ____min. (23) as needed for levels to less than 100 mg/dL (less than 70 mg/dL for opiate reversal to improve mentation and RR > 10 veryhighrisk patients); secondary goals of therapy and notify physician STAT include normalizing triglycerides and reducing non– Antipyretics highdensity lipoprotein cholesterol levels to less than c acetaminophen /TYLENOL 650 milligram orally or d e f g rectally every 4 hours as needed for fever >100.4 130 mg/dL Evidence c acetaminophen /TYLENOL 650 milligram orally or d e f g HMGCoA Reductase Inhibitors rectally every 6 hours as needed for fever greater c atorvastatin /LIPITOR 10 milligram orally once a d e f g than 100.4 day in the evening Laxatives atorvastatin /LIPITOR 20 milligram orally once a c d e f g c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g day in the evening milliliter orally once a day as needed for constipation atorvastatin /LIPITOR 40 milligram orally once a c d e f g c docusate sodium /COLACE 100 milligram orally 2 d e f g day in the evening times a day c simvastatin /ZOCOR 20 milligram orally once a day, d e f g c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g in the evening needed for constipation c simvastatin /ZOCOR 40 milligram orally once a day, d e f g c bisacodyl /DULCOLAX 10 milligram suppository d e f g in the evening rectally once a day as needed for constipation Anticoagulants DVT Prophylaxis c warfarin/COUMADIN ____mg orally daily. d e f g Mechanical methods of prophylaxis should be used Analgesics primarily in patients who are at high risk of bleeding or Mild Pain (13) Evidence as an adjunct to anticoagulantbased prophylaxis. acetaminophen /TYLENOL ____650 mg ____650 mg c d e f g Consider renal impairment when deciding on doses of orally or rectally _____every 4 hours ____every 6 LMWH, the direct thrombin inhibitors, and other hours as needed for pain antithrombotic drugs that are cleared by the kidneys, c ibuprofen /MOTRIN 400 milligram orally every 4 d e f g particularly in elderly patients and those who are at high hours as needed for pain risk for bleeding. (Contraindicated in pregnant women and children < 6 In acutely ill medical patients who have been admitted mos. of age) to the hospital with CHF or severe respiratory disease, Moderate Pain (46) or who are confined to bed and have one or more c hydrocodone/APAP/LORTAB d e f g adtioanla risk factors, inclujding active CA, previous ____5/500_____7.5/500 ______10/500 tablet orally VTE, sepsis, acute neurologic disease, or inflammatory every ____4 hr._____6 hr. as needed for pain bowel disease, prophylaxis with LDUH or LMWH is c oxycodoneAPAP/PERCOCET d e f g recommended. In meidcal patients with risk factors for ____5/325______7.5/325_____10/325 tablet orally VTE in whom there is a contraindication to anticoagulant every _____4hr._____6hr. as needed for pain prophylaxis, GCS or IPC is recommended. c oxycodone _____mg tablet orally every d e f g c Early and persistant mobilization d e f g _____4hr._____6hr. as needed for pain c Graded compression stockings (1530 mm Hg of d e f g pressure at the ankle)
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. c Sequential Compression Device d e f g c CBC every other day starting on day 4 of heparin d e f g Other:______________________ therapy thru day 14 or until Unfractionated c MRA neck ___with __without contrast. Evidence d e f g heparin/LMWH is discontinued. c MRA brain __with contrast __without contrast Evidence d e f g LowDose Unfractionated Heparin c MRI, brain, without contrast Evidence d e f g c heparin 5,000 unit subcutaneously every 8 hours d e f g c MRI, brain, with contrast Evidence d e f g LowMolecularWeight Heparins c Ultrasound, carotid, Doppler, bilateral Evidence d e f g c enoxaparin /LOVENOX 40 milligram subcutaneously g d e f g c Interventional radiology, angiogram, aortic arch study d e f once a day with intracranial vessels Stress Ulcer Prophylaxis c Interventional radiology, angiogram, carotid, cerebral, d e f g c Initiate Stress Ulcer Prophylaxis Protocol d e f g bilateral Evidence Laboratory c Interventional radiology, angiogram, carotid, cerebral, d e f g b Complete blood cell count with automated white blood c d e f g left Evidence cell differential Evidence c Interventional radiology, angiogram, carotid, cerebral, d e f g b Erythrocyte sedimentation rate (ESR) c d e f g right Evidence b Partial thromboplastin time (PTT), activated c d e f g c Interventional radiology, angiogram, carotid, cervical, d e f g b Prothrombin time (PT) and international normalized ratio c d e f g bilateral Evidence (INR) Evidence Interventional radiology, angiogram, carotid, cervical, c d e f g c Basic metabolic panel d e f g left Evidence c Comprehensive metabolic panel d e f g c Interventional radiology, angiogram, carotid, cervical, d e f g b Lipid panel c d e f g c Magnesium (Mg) Evidence d e f g right Evidence c Phosphorus level Evidence d e f g c Interventional radiology, angiogram, intracranial d e f g c Creatine kinase, total (CKtotal) , CKMB isoenzyme, d e f g Evidence troponin Consults c Rapid plasma reagin (RPR), qualitative d e f g c Consult to cardiology Evidence d e f g b Urinalysis (UA) with microscopy c d e f g c Consult to dietitian, adult Evidence d e f g c Toxicology drug screen, urine d e f g c Consult to internal medicine d e f g c Hypercoagulopathy panel (protein C deficiency, protein S d e f g c Consult to Acute inpatient rehabilitation Evidence d e f deficiency, lupus anticoagulant, anticardolipin antibodies, g c Consult to neurology d e f g activated protein C resistance, factor V Leiden, c Consult to occupational therapy d e f g Prothrombin gene analysis) c Consult to Palliative Care d e f g Avoid the routine ordering of tests to identify coagulation c Consult to physical therapy d e f g defects (eg, protein C deficiency, protein S deficiency, lupus anticoagulant, anticardiolipin antibodies, activated c Consult to speech therapy d e f g protein C resistance/factor V Leiden mutation) Evidence c Consult to vascular surgery Evidence d e f g Diagnostic Tests b 12lead ECG Evidence c d e f g c Echocardiogram, transthoracic Evidence d e f g c Echocardiogram, transesophageal Evidence d e f g c Radiograph, chest, 1 view Evidence d e f g c Radiograph, chest, 2 views Evidence d e f g c Radiograph, swallowing function, with cineradiography d e f g and/or videoradiography (modified barium swallow) Evidence c CT, head or brain, without contrast on admission d e f g Evidence c CT Angiography of the head Evidence d e f g c CT Angiography of the neck. Evidence d e f g Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
Print Only Selected Items
Print All
Related Documents
Stroke Ischemic
April 2020 17
Stroke - Ischemic With Lytic Therapy
May 2020 7
Stroke
November 2019 39
Stroke
December 2019 32
Stroke
November 2019 36
Hypoxia - Ischemic Encephalopathy
July 2020 2More Documents from "api-19916399"
Ugi Bleed
April 2020 15
Substance Abuse
April 2020 25
Chest Pain Low Risk
April 2020 19
Stroke Ischemic
April 2020 17
Stroke Hemorrhagic
April 2020 17