She has been in the hospital for 3 days with an acute COPD … COPD case presentation by Amnah AlLail 1. Try our expert-verified textbook solutions with step-by-step explanations. • COPD is incredibly common; estimates vary but likely > 6% population • COPD is the fourth leading cause of death (since 1994). Michael Nastase Date 09/29/20 Asthma and COPD Case Study Answers Asthma 1. This intervention is applied after a sputum culture to identify the cause of infection. COPD Patient Profile Hazel Merrick is a 68-year old married, female, retired police officer. (Lewis, Bucher, Heitkemper, & Harding, 2017) The patient also has a low PaOâ‚‚ and low oxygen saturation. A chest x-ray would be a reasonable … The patient also uses supplemental oxygen via nasal cannula to increase her PaOâ‚‚ and oxygen saturation levels. Case Questions for Medical Nutrition Therapy: A Case Study Approach 4th ed. It is the aim of this case study to analyse the holistic care of a patient with severe COPD. Evidence-based recommendations for the disease are similar to the actual treatment plan which was garnered from textbook information as well as student education. We've received widespread press coverage since 2003, Your NursingAnswers.net purchase is secure and we're rated 4.4/5 on reviews.co.uk. “The primary causes of [COPD] exacerbations are bacterial or viral infections” (Lewis, Bucher, Heitkemper, & Harding, 2017). If cor pulmonale is suspected an ECG may also be used to detect right-sided enlargement and BNP levels can be monitored since increased BNP levels indicate increased stretch.  The lab values should also continue to be monitored. These low levels are due to the air trapped in the patient’s lungs which decreases gas exchange as well as the patient’s dyspnea. Course Hero is not sponsored or endorsed by any college or university. • In the US, direct costs of COPD … Pneumonia-COPD 1. Question four Patients with an exacerbation of COPD usually present with increased sputum production, a change in sputum color compared with baseline, cough and/or worsening dyspnea. If this patient was producing sputum it would need to be collected and cultured and antibiotics would be prescribed, if appropriate. This will include: diagnosis, assessment and care planning of the patient, treatment of the disease, prevention of … If patient appears resistant to total cessation of smoking, use the “5 R’s” (relevance, risks, rewards, roadblocks, and repetition) to motivate the patient to quit smoking. Monitor respiratory and oxygenation status to assess need for intervention and give supplemental oxygen therapy as ordered to increase PaOâ‚‚ and improve Oâ‚‚ saturation levels. A bit more about Jim: Medical history: COPD… Title: Case 27 – COPD with Respiratory Failure. If the patient is producing sputum, a sample should be collected and cultured. It is not used for acute exacerbations. If increased Oâ‚‚ therapy of more than 35-50% is ordered, use a humidification or nebulization device to prevent drying secretions and mucous membranes. Pulmonary hypertension can cause complications of COPD, such as hypertrophy of the right ventricle (cor pulmonale) and ultimately right sided heart failure. Assess for co-morbidities such as osteoporosis, cardiovascular disease or psychologic problems to ensure patient comprehension and safe management of disease. All of the ABG abnormalities are related to each other. (Skidmore-Roth, 2017)  By combining these bronchodilators, DuoNeb “improves their effect and decreases the risk of adverse effects” (Lewis, Bucher, Heitkemper, & Harding, 2017). Provide the patient with printed information on nutrient dense foods to promote adequate nutrition. Recommend a “diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat” (Lewis, Bucher, Heitkemper, & Harding, 2017). Chronic cough can cause excess mucus production. Suspected in patients with a history of smoking, occupational and … Tremors, anxiety, insomnia, headache, dizziness, fever, tachycardia, palpations, hyper/hypotension, angina, dysrhythmias, dry nose, heartburn, N&V, abdominal pain, muscle cramps, bronchospasm, cough. COPD case presentation Prepared by: Sara Abudahab, Ala’a Alhayek and Amani Almani Supervised by: Dr. Abla Albsoul Jordan UniversityFaculty of pharmacy 2. Copyright © 2003 - 2021 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. Outline Patient presentation COPD assessment according to GOLD 2017 Pharmaceutical care plan Smoking cessation Newly approved drugs for COPD … Learn vocabulary, terms, and more with flashcards, games, and other study tools. The patient is a 76-year-old female with a history of chronic obstructive pulmonary disease (COPD). ... Case Study … The patient is still within normal BMI range at 19 but has lost 4kg (8.8lbs) in three months. This study also found that “a pattern of particular patient and nursing care behaviors were identified in the nurse caregiver stories and constituted what we have designated as a COPD-illness template” (Bailey, Colella, & Mossey, 2004). The patient may also complain of fatigue, decreased appetite and pain while coughing. A chest x-ray showed an increased AP diameter, flattening of the diaphragm, and decreased lung markings. Digital Edition: Diagnosis and management of COPD: a case study 04 May, 2020. COPD/Pneumonia SKINNY Reasoning Case Study Presentation. Instructions: Answer the questions below. Immediately report allergic reaction, rash, severe abdominal pain, yellowing of skin and/or eyes, tingling in the extremities or change in bowel habits. It has the same method of action as Tiotropium, inhibiting acetylcholine at receptor sites on bronchial smooth muscle, resulting in decreased cGMP and bronchodilation. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. The patient has recently lost weight, so nutritional therapy is important. The patient’s symptoms include patient report that she feels, “anxious, more fatigued than usual with a very poor appetite”, as well as increasing dyspnea described as “really bad now, I can’t breathe”. This LABA increases levels of cAMP, which relaxes pulmonary smooth muscle. Do not use a spacer. When 2 puffs are indicated, wait 1 minute between doses. Retrieved March 21, 2017. The patient’s age also contributes to her risk factors since “normal aging results in a loss of elastic recoil, stiffening of the chest wall, gas exchange alteration, and decrease in exercise tolerance” (Lewis, Bucher, Heitkemper, & Harding, 2017). (Lewis, Bucher, Heitkemper, & Harding, 2017) Possible symptoms include the patient complaining “of not being able to take a deep breath, heaviness in the chest, gasping, increased effort to breathe and air hunger” (Lewis, Bucher, Heitkemper, & Harding, 2017). This LAMA is used for long-term treatment and once-daily maintenance of bronchospasm associated with COPD. One study of patients reviewed at 14.5 years after stopping smoking showed … Rinse mouth after use. Share your impressions in our latest COPD case study. Free resources to assist you with your nursing studies! Reference this. Other risk factors include reoccurring respiratory tract infections in childhood, tuberculosis, asthma, aging, gender, and genetics. The patient is scheduled for follow up radiography in 24 hours. This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. This treatment is appropriate due to the rationale; the antibiotic is indicated if the exacerbation is in response to infection. If the patient is having trouble expectorating, teach and promote airway clearance techniques such as huff coughing to loosen secretions and promote expectoration. Cigarette smoke comprises of extremely high concentration of … State your rationale. Immediately report dyspnea after use if  ≥ 1 canister is used in 2 months time. Her oxygen saturation is low with a SaOâ‚‚ of 88%. Immediately report blurred vision, eye pain or halos. The patient’s white blood cell count is elevated which is indicative of an infection. Company Registration No: 4964706. Applied Nursing Research, 33, 85-92. Danielle McGarry Introduction The patient is a 76-year-old female with a history of chronic obstructive pulmonary disease (COPD). Combination therapy with long-acting inhaled anticholinergics or corticosteroids and ßâ‚‚-agonist are indicated for any patient with a FEV₁ less than 60% of the expected value. All work is written to order. If anemia does occur in patients with COPD, it could … Notify provider if >4 inhalations are needed. The patient’s pH is low at 7.25 which indicates acidosis. Smoking in conjunction with any of the other risk factors greatly increases the risk of COPD. It is used to decrease inflammation for management of acute exacerbation of COPD. Laboratory Values and Diagnostic Testing: Lab values for this patient are located in table 1 in the appendix. Powerpoint slides for COPD with the given case study by using CRC. Radiography is also used to monitor for complications. Rock active learning as an educator or if you are a student, use this written case study with fully developed answer … COPD– non-pharmacological approaches, exacerbations, oxygen therapy and care delivery. She has been in the. *You can also browse our support articles here >. The medical treatment section includes the medication, it’s classification, method of action, dose and frequency, as well as the reason the patient is taking the medication. The patient will also have a decreased FEV₁ and FEV₁/FVC. Nurses’ perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: A mixed method study. View Notes - Unfolding Case Study Pneumonia-COPD Case Study (with answers)(3)(1)(1)(1)(1) (1).docx from NURSING 13 at Riverside City College. Respiratory function and paradoxical bronchospasm. The patient needs to be monitored for signs and symptoms of pneumothorax such as decreased movement of the chest wall and hyperresonance to percussion. Ipratropium (Atrovent) is an anticholinergic and bronchodilator. You are the RN on a morning shift on the respiratory ward of a large … Methylprednisolone (Solu-medrol) is a corticosteroid (glucocorticoid), an anti-inflammatory. The patient’s lab values also reflect her disease process and are discussed under the laboratory values section. Her blood pressure is borderline hypotensive at 100/54. VAT Registration No: 842417633. 4668 words (19 pages) Nursing Essay. Titrated dose, use lowest effective dose. Respiratory status & paradoxical bronchospasm, Adult PO/IV 40-80 mg/day in 1-2 divided doses, Depression, flushing, sweating, headache, mood changes, circulatory collapse, thrombophlebitis, embolism, tachycardia, hyperglycemia, adrenal suppression/insufficiency, blurred vision, diarrhea, nausea, GI hemorrhage, peptic ulcer, pancreatitis, thrombocytopenia, poor would healing, osteoporosis, poor growth in children, candidiasis, dysphonia, Do not use with grapefruit juice, long-term po glucocorticoids must be given increased doses during times of increased physiologic stress, do not discontinue abruptly, increase intake of potassium, calcium & protein, carry emergency ID, take PO with food, avoid OTC products. 04.37 Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min) 04.45 Preeclampsia (45 min) 04.11 Emergent Delivery (OB) (30 min) The patient’s gender is also a risk factor due to the belief that “women may be more susceptible to the adverse effects of smoking” (Lewis, Bucher, Heitkemper, & Harding, 2017). ... Clinical Case Study on COPD. A 65-year-old man with a 60-pack-year history of cigarette smoking presents with worsening exertional dyspnea. Do you have a 2:1 degree or higher in nursing or healthcare? Chronic obstructive pulmonary disease (COPD) is a progressive disease state characterized by airflow limitation that is not fully reversible. Large pulmonary vessels could indicate cor pulmonale. (Lewis, Bucher, Heitkemper, & Harding, 2017). Suggest the patient rest at least 30 minutes before eating and break up meals into five or six small meals a day to conserve energy. Chronic obstructive pulmonary disease (COPD) is a group of common chronic … Over time, this injury-and-repair process causes scar tissue formation and narrowing of the airway lumen. COPD Case Study Patient and History: D.Z. He has 10-year history of hypertension. (Lewis, Bucher, Heitkemper, & Harding, 2017). This drug can cause paradoxical bronchospasm with dyspnea, wheezing, and chest tightness. The patient uses Serevent Diskus DPI (50 mcg/inhalation), 1 puff twice a day. a. Assess the patient’s ability to perform ADL’s and offer alterations to activities to prevent exacerbations. Tiotropium is a long-acting anticholinergic (muscarinic antagonist), and bronchodilator. Journal of Clinical Nursing , 756- 764. (Lewis, Bucher, Heitkemper, & Harding, 2017), Risk factors for COPD include exposure to noxious particles, especially cigarette smoke. Nursing Essay Start studying COPD Case Study. Air becomes trapped in the lungs which creates gas exchange abnormalities, and an increased volume of residual air, making passive expiration arduous. Ms Aaliyah Abimbola. Later signs of COPD are dyspnea at rest, chest breathing with use of intercostals and accessory muscles, barrel chest, weight loss, wheezing, diminished breath sounds, pursed-lipped breathing, cyanosis, and the patient sitting in a tripod position. The patient’s FEV₁ was 40% of expected value. St. Louis: Elsevier. Registered Data Controller No: Z1821391. If this complication were to occur, it is most frequently treated by inserting a chest tube with drainage. Case Study - COPD with answers.docx - COPD Patient Profile Hazel Merrick is a 68-year old married female retired police officer She has been in the, Hazel Merrick is a 68-year old married, female, retired police officer. Early signs include chronic cough, usually with sputum production and dyspnea, especially upon exertion. His … Pulmonary function testing showed significant restrictive lung disease that was thought to be secondary to the patient’s chronic obstructive pulmonary disease (COPD). Acidosis is also indicated by the patient’s increased carbon dioxide. An ECG may also be used to determine right ventricular hypertrophy. Use only Solu-Medrol IV, never use methylPREDNISolone acetate suspension IV. Breath in slowly and deeply, hold breath and remove mouthpiece, then resume normal breathing. Search. However, the current definition does not include either term, instead attributing them as contributors to the disease process. (Lewis, Bucher, Heitkemper, & Harding, 2017) Chronic inflammation causes structural deviations in the lungs which leads to airflow limitation and obstruction. We're interested in your thoughts on another COPD case study: Jim B., a 68-year-old man here for his Phase II Pulmonary Rehabilitation intake interview. Albuterol has the same method of action as Salmeterol, acting on ßâ‚‚ pulmonary receptors by increasing cAMP which relaxes bronchial smooth muscle. Drug-drug interactions with oral contraceptives, estrogens, diuretics, St. John’s wart. Respiratory acidosis is caused by a build-up of COâ‚‚, resulting in increased carbonic acid in the blood. Patient’s ability to self-medicate. This medication has drug-drug interactions with CPY3A4 inhibitors, aerosol bronchodilators, tricylics, MAOI’s and ß-blockers. The patient may also alter their activities to avoid dyspnea, eventually having to modify their activities of daily living. This case study explains the symptoms, causes, pathophysiology, diagnosis and management of chronic … The patient may have decreased PaOâ‚‚ and pulse oximetry reading as well as an increased PaCOâ‚‚, HCO₃⁻ and hemoglobin. The patient was also prescribed DuoNeb solution (500 mcg ipratropium and 2500 mcg albuterol in 3-mL) via nebulizer STAT and every 6 hours. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! The patient reports an increasing use of oxygen in the home over the past five years and is requiring at least 2L/min continuously over the last year. Background information for the assignment. All of these signs and symptoms are manifestations of the patient’s inadequate oxygenation due to an exacerbation of her COPD. The patient is also on supplemental oxygen via nasal cannula at 3L/min and IV fluids of normal saline at 80 mL/hr. COPD Case Study - Winter 211 From BCP 323-3797 Chandler Bing is a 52 year old male admitted for management of influenza B. Pt is a current smoker with a 4Opkyr history. As the disease process progresses, functional residual capacity is increased and air trapping causes chest hyperextension and the patient may become barrel chested and the diaphragm may flatten. Disclaimer: This essay has been written by a student and not our expert nursing writers. This intervention was developed to meet the health needs of COPD patients “such as the need of a better understanding of the sustained symptom burden, physical limitations, and psychological impact of COPD” (Weldam, Lammers, Zwakman, & Schuurmans, 2017). The patient’s HCO₃⁻ should also be monitored to observe renal compensation and to monitor for decompensation and metabolic alkalosis. Are B.T.’s vital signs (VS) acceptable? Low levels of ATT can be detected by a blood test. Salmeterol (Serevent Diskus) is a long-acting ßâ‚‚-adrenergic agonist, and bronchodilator. Avoid OTC medications. Drug-drug interactions. These are all physical manifestations of COPD as aforementioned in the pathophysiology of COPD. The patient has a 61 pack-year history (number of packs smoked per day multiplied by number of years smoked) and still currently smokes “to calm her nerves”. Practice Nurse, 30(4), 59-68. Start studying COPD case study answers. Booker, R. (2005, 09 09). Severe ATT deficiency leads to premature bullous emphysema in the lungs” (Lewis, Bucher, Heitkemper, & Harding, 2017). Oxygen therapy is also used to correct hypoxemia. Infection is the … Chest x-ray and spirometry are the most appropriate initial diagnostic measures for a patient suspected of having COPD. Please print the questions out with your answers … 12th Feb 2020 This diagnostic value determines the medication treatment. Chronic obstructive pulmonary diseases (COPD) Adult Case Study Explain the role of smoking in the pathogenesis of COPD. This preview shows page 1 - 2 out of 3 pages. Adult inhale content of 1 cap/day (18 mcg) using HandiHaler inhalation device or 2 INH (spray) 2.5 mcg each daily. Renal compensation of respiratory acidosis manifests in increased levels of HCO₃⁻ and increased levels of H⁺ in urine. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. It is used to prevent bronchospasm in COPD patients and maintains improvement in forced expiratory volume (FEV) from 3 to 12 hours. Bailey, P., Colella, T., & Mossey, S. (2004). Learn vocabulary, terms, and more with flashcards, games, and other study tools. (Lewis, Bucher, Heitkemper, & Harding, 2017), Once the exacerbation has subsided, nursing interventions would focus on patient teaching. Previously the definition of COPD included chronic bronchitis and emphysema due to their contribution to mucus hypersecretion and destruction of alveoli respectively. Assess the patient’s ability and technique when using MDIs and DPIs via patient demonstration in order to confirm proper use of medications and alter or simplify medication regime if necessary. Estimated to be the third leading cause of death by 2020. Avoid getting powder in eyes. Dose range, route, adverse effects, patient education, implementation, and assessment for these medications are located in table 2 in the appendix. Find answers and explanations to over 1.2 million textbook exercises. He is alert and oriented, but … These interventions and additional interventions are discussed during nursing and medical treatments for the disease process. This intervention is aimed at treating the patient as a whole, including improving their health-related quality of life. The patient should be monitored for signs and symptoms of cor pulmonale such as dyspnea upon exertion, cough, tachypnea, fatigue and an increased S2 sound. It works by inhibiting acetylcholine at receptor sites of bronchial smooth muscle, resulting in decreased cGMP and bronchodilation. Weldam, S., Lammers, J.-W., Zwakman, M., & Schuurmans, M. (2017). This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. Store at room temperature. A 74-year-old causation male with a diagnosis of pulmonary emphysema ,he was seen in the emergency department with a … She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep. (Lewis, Bucher, Heitkemper, & Harding, 2017) (Skidmore-Roth, 2017) Emergency Department: The patient was prescribed Solu-medrol, 50 mg IV, every 6 hours. Do not give intrathecally. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. The patient is a married housewife with a 1 pack a day smoking history from age 15. The patient states that she, “only smokes a little to calm her nerves” though her husband still continues to smoke in the home. “The main function of ATT, an α₁ -protease inhibitor, is to protect normal lung tissue from attack by proteases during inflammation related to cigarette smoking and infections. Before admission, had 7 days of exceptional shortness of breath and increased volume, Had increased salbutamol use at home to five or six times a day for dyspnea, Had three or four bouts of exacerbations of COPD in the past year that she treated at, Thirty pack-year history of smoking; smokes half a pack per day now to “clear out lungs”, Cannot climb one flight of stairs without stopping; walks down the flat driveway 10 yards, Awakens 2-3 times per night coughing and short of breath, Weight 58.5kg (129lbs); height 1.73m(5 ft 8 in); BI 20kg/m, Blood pressure 136/76; pulse 86; respiratory rate 28, Increased anteroposterior diameter of chest (barrel-shaped), Slight use of accessory (neck) muscles with breathing, Diminished breath sounds with occasional wheezes, ABG measurements on admission: pH 7.34; PaCO2 49; HCO3 27; PaO2 70, Chest radiograph – hyperinflation, flat diaphragm, no sign of pneumonia, COPD stage: severe COPD with acute exacerbation, O2, 2L via nasal cannula while in hospital. There is minimal consolidation in the right upper lung. The inflammatory response occurs throughout the airways, parenchyma, and pulmonary vasculature Because of the chronic inflammation and the body’s attempts to repair it, narrowing occurs in the small peripheral airways. Medical-Surgical Nursing Assessment and Management of Clinical Problems. The patient should also use spirometry to measure their FEV₁/FVC ratio to monitor the effects of the medications. (Lewis, Bucher, Heitkemper, & Harding, 2017), COPD is a progressive disease and clinical manifestations develop slowly. If patient is able to expectorate sputum, assess and monitor sputum volume and purulence to detect possible infection. Avoid smoking. Oxygen therapy is also recognized as a primary treatment. COPD-intuition or template: nurses’ stories of acute exacerbations of chronic obstructive pulmonary disease. Albuterol (Proventil) is a ßâ‚‚-adrenergic agonist, bronchodilator, and sympathomimetic. Recommend the patient to a pulmonary rehabilitation clinic and/or a support group to promote smoking cessation. Some nursing interventions also focus on self-management of COPD exacerbations and “are aimed at helping patients to recognize and respond promptly and appropriately to an exacerbation” (Booker, 2005), though it was also stated that the effectiveness of self-management has not been proven (Booker, 2005). Meet Susan M! Mosby’s 2017 Nursing Drug Reference . Late in COPD, pulmonary hypertension may occur as a result of thickening of the vascular smooth muscle. Data Collection History of Present 12th Feb 2020 Nursing ... NursingAnswers.net is a trading name of All Answers … COPD case presentation 1. This medication is contraindicated if the patient also takes atropine and is pregnancy category C. This medication is not for immediate relief of breathing problems. Be detected by a student and not our expert nursing writers s pH is low with a pack... Compensation of respiratory acidosis manifests in increased H⁺ which is the aim of this therapy via ABGs pulse. Nursing... NursingAnswers.net is a long-acting ßâ‚‚-adrenergic agonist, bronchodilator, and other tools... Air, making passive expiration arduous of antibiotic is indicated if the is. Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ a build-up of COâ‚‚, in..., further decreasing gas exchange abnormalities, and more with flashcards, games, and other tools... With flashcards, games, and chest tightness for this patient are in! Therapy is also increased blebs can form, further decreasing gas exchange though albuterol is short acting ( SABA and... Att deficiency leads to premature bullous emphysema in the pathophysiology of COPD chronic... With sputum production and dyspnea, eventually having to modify their activities of daily living have! Early signs include chronic cough, usually with sputum production and dyspnea, wheezing, and with... 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We 've received widespread press coverage since 2003, your NursingAnswers.net purchase is secure and 're., assess and monitor sputum volume and purulence to detect possible infection huff coughing to secretions... Usually with sputum production and dyspnea, especially upon exertion to ensure patient comprehension and safe management of acute of!, occupation chemicals and dusts and air pollution movement of the chest wall and hyperresonance to percussion therapy..., Nottinghamshire, NG5 7PJ patient at risk of spontaneous pneumothorax are correct, decreasing permeability! Have continued radiography in order to monitor for decompensation and metabolic alkalosis a build-up of COâ‚‚ resulting... Cap/Day ( 18 mcg ) using HandiHaler inhalation device or 2 INH ( spray ) mcg... His chronic obstructive pulmonary disease STAT and every 6 hours retired police officer tract infections in childhood,,! 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Of her COPD are B.T. ’ s vital signs ( VS ) acceptable booker R.. Well as student education puffs are indicated, wait 1 minute between doses study Presentation and emphysema due the! 27, 2018 February 1st, 2019 no Comments and an increased volume of residual,! Diffuse rhonchi and some faint, expiratory wheezing NursingAnswers.net is a 68-year old married, female, retired police.... Should also be monitored to observe renal compensation of respiratory acidosis manifests increased! That she always removes her nasal cannula before smoking also use spirometry to measure their FEV₁/FVC ratio monitor. Solution ( 500 mcg ipratropium and 2500 mcg albuterol in 3-mL ) via nebulizer STAT and every 6 hours in forced volume. Each daily support group to promote smoking cessation are indicated, wait 1 minute between doses determine ventricular...