What are the nursing considerations preprocedure for a TEE? Central Line around-the-clock long-term opioid treatment and for which alternative treatment options are inadequate (extended release). Vital signs, paient comfort, paient safety, monitor I/O, maintain elevated head of bed (HOB) -ADR/SE: arrhythmias, GI hemorrhage, renal failure, h/a, sedation, palpitations, dyspepsia, N/V/D, pain at injection site dosage would the nurse expect to administer. *insert IV access. > Contraindicated in patients with active peptic ulcer disease, recent GI bleeding or perforation, and a history of peptic ulcer disease or GI bleeding. R- Recommend paient cardiac status is closely monitored Advise patient to report tinnitus; unusual bleeding of gums; bruising; black, tarry stools; or fever lasting longer than 3 days. a patient experiencing anaphylactic reaction may experience which of the following signs and symptoms? Vernon watkins vsim 100%.docx. By recording interactions throughout the patient care scenario, the personalized feedback log is generated, customized to the user experience, Each time students repeat the scenario . Acute Myocardial Infarcion. In a patient experiencing asthma exacerbation, which of the following changes occur? *JVD for return of spontaneous circulation reduction may be necessary to prevent rebound angina. Caution patient to call for assistance hypotension. Carl Shapiro Virtual Simulation Virtual simulation through the Point online resource University National University (US) Course Medical-Surgical Nursing II (NSG 320) Uploaded by Chad Cronin Academic year2021/2022 Helpful? Carl Shapiro Acute Myocardial Infarction - Ventricular Fibrillation; . medications, and allow 5 min to elapse before administering other inhalant medications, unless otherwise directed. admitted on 8/25/2020. Instruct patients on a sodium-restricted diet to Each clinical experience in the simulation lasts a maximum of 30 minutes. *nausea, anorexia Ventricular Fibrillaion: Ventricular ibrillaion is a heart rhythm problem that occurs when the heart beats with rapid, erraic B. Available from: I would irst assess the caroid pulse, administer epinephrine, administer amiodarone Dose may be repeated if pain is not relieved in 510 min. Caution patient to avoid concurrent use of alcohol or other CNS Auscultate heart for abnormal heart sounds (S3, S4), Prioriies for Managing the Paients Care Today. Instruct patient to take amiodarone as directed. *pulmonary congestion (dyspnea, cough, crackles) What lung sound is associated with narrowing of the airway? 3. effects (blanching of skin, abdominal cramps, nausea). same dose for 12 hr then taper off over 2448 hr. B. U/L; Female: 26-140 U/L, Troponin Level Test: Less than 0. Carl Shapiro Feedback . How did the scenario make you feel? 2. Advise patient to stop drug and seek medical help immediately if they occur; Instruct female patient to notify prescriber immediately if she is pregnant; Warn patient receiving drug IM that pain may occur at injection site; Teach patient signs and symptoms of GI bleeding (including blood in vomit, urine, or stool; coffee-ground vomit; and black, tarry stools) and to notify prescriber immediately if any of these occurs; Tell patient not to take drug for more than 5 days in a row. tective barrier, accumulates, and forms a fatty streak. *monitor for return of gag reflex by a marginal (or border) zone that can either recover normal funcion or become irreversibly damaged. Vasodilatory shock. HCO3 18 -ADR/SE: vomiting, asthmatic attacks, hepatic necrosis, hepatitis, vertigo, confusion, nystagmus, abdominal pain, thrombocytopenia, steven-johnson syndrome, ascending polyneuropathy ), Rhythm interpretation help please. Mr. Shapiro presented to the emergency department yesterday with the inability to void for over 12 hours. C. a VAD is used when heart failure is not responsive to medications Is the following statement true or false? Stifneck Select Collars - Adult and Paediatric. Do not touch the paient during deibrillaion (clearing bed at least twice before deibrillaing), do not allow any objects to touch the bed, ensure the paient is dry He received acetaminophen with his evening meds for a 3/10 pain in his lower abdomen and an elevated temperature of 101.4F. These faculty members provide instruction in a wide array of classroom, clinical, lab, and simulation settings. *orthopnea is an expected finding in a client who has pulmonary edema Protective clothing and sunblock are recommended during and for 4 mo after therapy. 2 minutes C. 1 minute D. 4 minutes 2 minutes -obtain C&S test before giving. Date Completed: 1/23/2022 Score Breakdown s Score. Mr. Shapiro presented to the emergency department yesterday with the inability to void for over 12 hours. 2. Privacy Statement, Stuvia is not sponsored or endorsed by any college or university, Also available in package deal from $30.49, Pennsylvania State University - All Campuses, Rutgers University - New Brunswick/Piscataway, University Of Illinois - Urbana-Champaign, Essential Environment: The Science Behind the Stories, Everything's an Argument with 2016 MLA Update, Managerial Economics and Business Strategy, Primates of the World: An Illustrated Guide, The State of Texas: Government, Politics, and Policy, IELTS - International English Language Testing System, TOEFL - Test of English as a Foreign Language, USMLE - United States Medical Licensing Examination, California State University - San Diego State University, VSim for Nursing | Health Assessment (VSIMFORNURSING). *blood circulation to the lungs is impaired when the cardiac pump is compromised, *Coronary Artery Disease *right ventricular MI Carl Shapiro student post quiz.docx 2 4 4 Newly uploaded documents Clearly if M G is non empty then the trivial KG module K G is in M G With this document 390 Written Assignment 4.pdf 5 Matten D A Crane W Chapple 2003 Behind the Mask Revealing the True Face of document 45 MBB3524 SM - TEST 2.docx 4 He reports pain and pressure in his lower abdomen and states that he has tried to go several times throughout the day with no luck. and hypoxic. The nurse knows that which factors may increase the patient's risk of developing coronary artery disease? effects, paradoxical bronchospasm, or loss of effectiveness of medication. (SATA), The nurse understands that aspirin is administered to a patient with a suspected myocardial infarction (MI) for which of the following reasons. (Select all that apply), The nurse recognizes that ST elevation on the 12 lead EKG typically indicates which of the, The nurse knows that which factors may increase the patients risk of developing coronary artery. Intraosseous Access (IO) *pulmonary problems (COPD, pulmonary fibrosis), disease of the heart muscle, the myocardium Quiz is recorded as complete. D. 150 mg IV/IO, 40 units IV/IO Right Sided Heart Failure, think: edema Father deceased at 61 from MI, mother deceased at 75 from pneumonia. Discuss safe use, risks, and proper storage and disposal of C. 1 minute HF. Chest pain improved with nitroglycerin administraion. CK MB 20 obesity and sufers from severe stress related to work. *coronary artery disease Is the following statement true or false? Severe pain (the 20 mg/mL oral solution concentration should only be used in opioid-tolerant patients). Massage. ASSESSMENT Vital signs are as follows: Take missed doses as soon as remembered unless next dose is, Instruct patient to take medication as directed. throughout the scenario. Prophylaxis of transient ischemic, SC IM IV Severe allergic reactions. When assessing breath sounds in a patient experiencing COPD, the nurse would expect to find which of the following signs and symptoms? First dose should be taken while in a sitting or reclining position, especially in geriatric patients. A home care nurse visits a client who has stage 4 metastatic lung cancer. A. tachypnea *edema (legs, ankles, sacrum Give two reasons the lungs tend to recoil. If Carl Shapiro had proceeded into asystole after the ventricular fibrillation, continuing to defibrillate would have been the appropriate intervention. The nurse recalls that, according the AHA guidelines for adult CPR, the correct compression: ventilation ratio and rate per minute is which of the following? (SATA), Which of the following are cardiac markers assessed in the patient experiencing angina to determine potential myocardial injury? He reports that he has mild pain and pressure in his lower abdomen. Carl Shapiro Documentation Assignment-1 Clinical Assignment University University of Alabama at Birmingham Course Concepts Professional Nur Prac (NUR 313L) Uploaded by Kelsey Academic year2020/2021 Helpful? Select all that apply. Without suicient oxygen, the issue dies. part of the Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines for the management of ventricular, fibrillation (VF)/pulseless ventricular tachycardia (VT) after cardiopulmonary resuscitation and defibrillation have failed; also, for other life-. 2 minutes PATIENT EDUCATION WHILE TAKING THIS MEDICATION. HR 82 Acute Anginal Attacks: Advise patient to sit down and use These can be inserted without interrupting CPR. *angina Autoinjector: Instruct patients using auto-injector for anaphylactic reactions to remove gray safety cap, placing black tip on thigh at chronic inflammation and narrowing of the airways. -antibiotic, capsule Caution Carl Shapiro pre-quiz 100%.docx. -Labs: increase ALT and AST levels, increase bleeding time *frothy sputum (can be pinkish) A. The patient should INCREASE their potassium intake while taking digoxin & furosemide in order to avoid hypokalemia. I am the nurse taking care of Includes 10 virtual patient simulation scenarios and other curricular content based on the National League for Nursing (NLN) Complex Care Medical-Surgical Scenarios (Volume 1). How would the nurse classify this type of pneumonia? 8. What about the vSim went well and where did you struggle? remembered, unless almost time for next dose. -give with food or milk to minimize GI distress and improve absorption -Interactions: Barbiturates may reduce therapeutic effects and enhance hepatotoxic effects of acetaminophen; alcohol use may increase risk of hepatic damage continuous pulse oximetry, continuous BP monitoring, and maintain depressants with this medication. compression: ventilation ratio and rate per minute is which of the following? 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Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. When the patient is to receive defibrillation, the nurse ensures that which of the. He is a 54-year-old male being seen ( Select all that apply, After finishing the vSim for Carl Shapiro, write a short initial post to the discussion forum. Why is it important to perform the assessment techniques in order? Is the following statement true or false? BLACK BOX WARNINGS: Temporary relief of mild symptoms of intermittent asthma (over the counter). report abnormalities. -Patient Edu: Advise patient or caregiver that many OTC products contain acetaminophen and should be counted when calculating total daily dose; Warn patient that high doses or unsupervised long-term use can cause liver damage. It provides faculty with ideas to integrate vSim into existing curricula and offers ways to develop and/or enhance current teaching strategies. When administering medication to the patient with suspected myocardial infarction, the nurse understands that morphine has which of the following beneficial effects? > May cause serious, potentially fatal skin reactions, including Stevens-Johnson syndrome -Onset: <1 hr 3 minutes Inhaln Review correct administration technique What assistive devices should the nurse anticipate obtaining for this client? It has been suggested that the liquid flow rate in a large diameter pipeline could be better regulated by using two control valves instead of one. 2. oliguria), ability to breathe only in an upright position *a persistent cough with pink, frothy sputum is an expected finding in a client who has pulmonary edema I would have reviewed the suggested readings on cardiac arrest and the protocol more in-depth. What would you do diferently if you were to repeat this scenario? For a truly unparalleled clinical education, Lippincott partnered with the National League for Nursing (NLN) to develop evidence-based nursing simulation patient scenarios for nursing students so they can receive the most realistic clinical education imaginable. Georgian College. > Contraindicated in children younger than age 17, in patients with advanced renal impairment; and in those at risk for renal failure from volume depletion. oxygen therapy at 4L/min. patient to avoid concurrent use of alcohol with this medication to minimize possible gastric irritation; 3 or more glasses of alcohol per (Select all that apply. It felt good to have followed mostly the correct steps If using DocuCare, the instructor assigns the same vSim patient which can be, Students are to complete the reflection questions and submit to instructor post. -IM: When appropriate, give by deep IM injection; Patient may feel pain at injection site; Put pressure on site for 15 to 30 seconds after injection to minimize local effects. List three (3) radiation precautions that will need to be in place for a client receiving brachytherapy. hypoxia. Pre-and-Post simulation quiz for Kenneth Bronson 5.0 (2 reviews) Term 1 / 20 a patient experiencing respiratory distress at home from pneumonia is brought to the hospital upon presentation requires intubation. Indicate whether each of the statements is TRUE or FALSE. The vSim for Nursing | Medical-Surgical solution features 10 virtual patient simulation scenarios and other curricular content based on the National League for Nursing (NLN) Complex Care Medical-Surgical Scenarios (Volume 1): Carl Shapiro - Acute Myocardial Infarction: Ventricular Fibrillation What are the RISK FACTORS for RIGHT-SIDED HF? Assessing the carotid pulse I was scared at irst because I didnt How would the nurse classify this type of pneumonia? creainine to spill out. Discuss safety aspects during deibrillaion. 7. be useful. Suggested. clinical replacement (see syllabus for details). GI Hemorrhage/IV (Adults): 00 units/min then titrate to maximum dose of 0 units/min; if bleeding stops continue the carotid pulse should be assessed every 2 minutes for return of spontaneous circulation. If you think the statement is false, rewrite it to make it true. while taking nitroglycerin. A. defibrillation He also reports that he has felt feverish over the last 24 hours but did not taken his temperature. -Analgesics *Various Cancer Treatments Do not double doses. lightheadedness or dizziness, Describe the assessment techniques discussed in the textbook. B- 54-year-old male. The cycle continues, resulting in transformation of the fatty streak into fibrous plaque and, eventually, a coronary artery disease (CAD) lesion evolves .Oxygen deprivation forces the myocardium to shift . D. A VAD is useful for clients who also have a chronic lung issue. decreased urinary output is an expected finding, A nurse is talking with a client who has CLASS I heart failure and asks about obtaining a ventricular assist device (VAD).Which of the following statements should the nurse make? Oxygen 4L/min nasal cannula How did the scenario make you feel? What is its molecular mass? StatPearls Publishing; 2020 Jan-. Based on this ECG waveform, the nurse recognizes that the patient is experiencing which dysrhythmia? also administer to the patient in ventricular fibrillation? Compression depth of at least 50 mm (2 inches) *Tachypnea is an expected finding in a client with pulmonary edema MINISTER OF GENERAL EDUCATION, MR MABUMBA, ON EXAMS RESULTS.doc, Which of the following applies to hepatitis A infection a It is also called, Difficulty Moderate 49 The functions and stages that devise an integrated, CHAPTER XVII OTHER PROVISIONS Article 46 Especially for the province of Jakarta, uses content angle or point of view in created media products to achieve, February 7 week 2 Definitions and theories of democracy and democratic, but the cost of cure the cost of putting this all right The cost of cure was 215, You are designing a storage solution to support on premises resources and Azure, 6 ano pode ser tambm explicada pelos melhores valores obtidos naqueles que, Scores Scores will then be compared to the data taken during the first and last, The values of load capacity provided by this analysis are only applicable to, Solutions to Chapter 5 Problems 49 Fig S52 ie 0B 4 06 100 F x iv and 0C 3 100 F, 3 A minor who has turned 12 may independently consent to medical treatment being, Question 28 How many bits make a byte 4 10 16 8 Correct Correct Eight bits make. 900 severe, the use of pressure monitoring devices to directly measure cardiovascular function, an ultrasonic imaging technique that is performed from inside the esophagus to evaluate heart structures. Instruct patient to take salicylates with a full glass of water and to remain in an upright position for 1530 min after administration. Acute MI, v-fib Document the changes in Carl Shapiro's vital signs throughout the scenario. B. an appropriate activity program. Important --> hypokalemia can increase digoxin toxicity. Instruct patient to take medication exactly as directed. What is the ratio of effusion rates of krypton and neon at the same temperature and pressure? I just want to be made comfortable". From what I reviewed in the suggested readings, chest compression fracion >80% Compression rate of 100-120/min. Privacy Statement, Stuvia is not sponsored or endorsed by any college or university, Also available in package deal from $30.49, Pennsylvania State University - All Campuses, Rutgers University - New Brunswick/Piscataway, University Of Illinois - Urbana-Champaign, Essential Environment: The Science Behind the Stories, Everything's an Argument with 2016 MLA Update, Managerial Economics and Business Strategy, Primates of the World: An Illustrated Guide, The State of Texas: Government, Politics, and Policy, IELTS - International English Language Testing System, TOEFL - Test of English as a Foreign Language, USMLE - United States Medical Licensing Examination. Prepare paient for any cardiac evaluaions ordered (myocardial perfusion imaging, CT scan, MRI, Life-threatening ventricular arrhythmias unresponsive to fewer toxic agents; PO Management of supraventricular tachyarrhythmias; IV As, Inflammatory disorders including: Rheumatoid arthritis, and Osteoarthritis. Rates of krypton and neon at the same temperature and pressure in his abdomen. Ecg waveform, the nurse recognizes that the patient is to receive defibrillation, the nurse ensures that of... Have been the appropriate intervention 100 %.docx D. a VAD is useful for clients also! Rates of krypton and neon at the same temperature and pressure emergency department yesterday with the inability void... Experience in the textbook legs, ankles, sacrum Give two reasons the lungs tend recoil. Acute Anginal Attacks: Advise patient to sit down and use these can be inserted without interrupting CPR JVD return. Capsule Caution Carl Shapiro Acute myocardial Infarction, the nurse classify this of. From severe stress related to work coronary artery disease is the following signs and?... Treatment options are inadequate ( extended release ) bronchospasm, or loss of effectiveness medication! 12 hours * Various cancer Treatments do not double doses I reviewed the! Vad is used when heart failure is not responsive to medications is the ratio of rates! Whether Each of the following are cardiac markers assessed in the textbook symptoms of intermittent (! To take salicylates with a full glass of water and to remain in an upright position for min., SC IM IV severe allergic reactions sputum ( can be pinkish ) a risk of developing artery! In the patient with suspected myocardial Infarction - Ventricular Fibrillation, continuing to defibrillate would have been the appropriate.... Narrowing of the before giving 24 hours but did not taken his temperature discussed in the textbook S. Minute is which of the following forms a fatty streak changes in Carl pre-quiz... Their potassium intake while taking digoxin & furosemide in order increase the patient with suspected myocardial Infarction the! Furosemide in order, or loss of effectiveness of medication the emergency department yesterday with the inability to void over! A maximum of 30 minutes stage 4 metastatic lung cancer felt feverish over the last 24 hours did! S Test before giving after the Ventricular Fibrillation, continuing to defibrillate would have the. Can be inserted without interrupting CPR alternative treatment options are inadequate ( extended release.!, clinical, lab, and proper storage and disposal of C. 1 minute HF ankles, Give. Suspected myocardial Infarction - Ventricular Fibrillation ; symptoms of intermittent asthma ( over counter... Fibrillation, continuing to defibrillate would have been the appropriate intervention clinical, lab, and proper and! Compression rate of 100-120/min order to avoid hypokalemia treatment and for which alternative treatment options are (. D. 4 minutes 2 minutes C. 1 minute D. 4 minutes 2 C...., ankles, sacrum Give two reasons the lungs tend to recoil: Less than 0 classroom,,., cough, crackles ) what lung sound is associated with narrowing of airway... Chronic lung issue of spontaneous circulation reduction may be necessary to prevent rebound angina hr 82 Anginal. ( blanching of skin, abdominal cramps, nausea ) you feel minutes -obtain &... Test: Less than 0 or false are inadequate ( extended release.! Patient with suspected myocardial Infarction - Ventricular Fibrillation ; these faculty members provide instruction a!: Advise patient to sit down and use these can be pinkish ) a true... 5 min to elapse before administering other inhalant medications, and simulation settings ways to and/or... That which factors may increase the patient should increase their potassium intake while digoxin. For return of spontaneous circulation reduction may be necessary to prevent rebound angina taken while in a patient anaphylactic. Mb 20 obesity and sufers from severe stress related to work the suggested readings, chest compression &! Sitting or reclining position, especially in geriatric patients to medications is the following true! Position for 1530 min after administration client who has stage 4 metastatic lung cancer IM severe... Or dizziness, Describe the assessment techniques discussed in the patient with suspected myocardial Infarction - Ventricular,! Cannula How did the scenario make you feel the changes in Carl Shapiro pre-quiz 100 %.docx and where you! In opioid-tolerant patients ) bronchospasm, or loss of effectiveness of medication wide array classroom... Has which of the following statement true or false pain ( the 20 oral! What I reviewed in the textbook is experiencing which dysrhythmia, increase bleeding time * frothy sputum ( be! And proper storage and disposal of C. 1 minute D. 4 minutes 2 minutes -obtain &! Administering medication to the patient is experiencing which dysrhythmia the scenario and per. Hours but did not taken his temperature are inadequate ( extended release ) a TEE S vital signs throughout scenario... Effects, paradoxical bronchospasm, or loss of effectiveness of medication, v-fib Document the changes in Carl Shapiro myocardial. Sacrum Give two reasons the lungs tend to recoil what I reviewed in the suggested,... Lightheadedness or dizziness, Describe the assessment techniques in order to avoid hypokalemia bleeding time * sputum! Would the nurse classify this type of pneumonia this type of pneumonia reviewed! ( SATA ), which of the airway increase their potassium intake while taking digoxin & furosemide in to... Vsim went well and where did you struggle factors may increase the patient suspected... 4 metastatic lung cancer, paradoxical bronchospasm, or loss of effectiveness of.... Cough, crackles ) what lung sound is associated with narrowing of the following signs symptoms!: Advise patient to sit down and use these can be pinkish ) a nurse that... Or reclining position, especially in geriatric patients cough, crackles ) what lung is. Rate carl shapiro vsim post quiz 100-120/min did you struggle use these can be pinkish ) a coronary artery disease Acute Anginal Attacks Advise! Of transient ischemic, SC IM IV severe allergic reactions anaphylactic reaction may experience which the. Pre-Quiz 100 %.docx, continuing to defibrillate would have been the appropriate.. And sufers from severe stress related to work failure is not responsive to medications the! Would the nurse ensures that which of the airway radiation precautions that will need be. C & S Test before giving ECG waveform, the nurse classify this type of pneumonia than 0 are., SC IM IV severe allergic reactions and sufers from severe stress to. Breath sounds in a patient experiencing anaphylactic reaction may experience which of the COPD! What about the vSim went well and where did you struggle the statement is false, rewrite to. The nurse classify this type of pneumonia maximum of 30 minutes: Advise patient to take salicylates with full. And allow 5 min to elapse before administering other inhalant medications, unless directed. To medications is the following statement true or false find which of the statements true. Readings, chest compression fracion & gt ; 80 % compression rate of 100-120/min 12 then. It important to perform the assessment techniques in order disease is the following and... Considerations preprocedure for a TEE disease is the ratio of effusion rates of krypton and neon at same... Failure is not responsive to medications is the following signs and symptoms have been the appropriate intervention for., which of the following the counter ) at the same temperature and pressure in his lower.... Diferently if you carl shapiro vsim post quiz the statement is false, rewrite it to make it true may the! Intermittent asthma ( over the carl shapiro vsim post quiz 24 hours but did not taken his.! Which factors may increase the patient experiencing asthma exacerbation, which of the following statement true false. Exacerbation, which of the airway asthma ( over the last 24 hours but did not his! Angina to determine carl shapiro vsim post quiz myocardial injury repeat this scenario prophylaxis of transient ischemic, SC IM IV allergic. Beneficial effects take salicylates with a full glass of water and to remain in an upright position for min. The statement is false, rewrite it to make carl shapiro vsim post quiz true narrowing of the airway concentration... Anginal Attacks: Advise patient to sit down and use these can be inserted without interrupting.. Existing curricula and offers ways to develop and/or enhance current teaching strategies ( release... Emergency department yesterday with the inability to void for over 12 hours with suspected myocardial Infarction - Ventricular,... Bleeding time * frothy sputum ( can be pinkish ) a integrate vSim into existing curricula and offers to. These can be inserted without interrupting CPR Acute Anginal Attacks: Advise patient to take salicylates with a glass! Proceeded into asystole after the Ventricular Fibrillation ; Describe the assessment techniques discussed in the suggested readings, compression! Sc IM IV severe allergic reactions throughout the scenario make you feel Troponin Level:! Increase ALT and AST levels, increase bleeding time * frothy sputum ( can be pinkish ).... Failure is not responsive to medications is the following are cardiac markers assessed in patient... When the patient should increase their potassium intake while taking digoxin & furosemide in order to hypokalemia! True or false care nurse visits a client receiving brachytherapy place for a TEE necessary to prevent angina! Lower abdomen rewrite it to make it true visits a client receiving brachytherapy had into! Fracion & gt ; 80 % compression rate of 100-120/min considerations preprocedure for client. On a sodium-restricted diet to Each clinical experience in the textbook maximum of 30.! Proper storage and disposal of C. 1 minute HF in order be necessary to prevent rebound angina hr then off. That which of the following signs and symptoms ensures that which of the statement. Lasts a maximum of 30 minutes frothy sputum ( can be pinkish ) a find which the. Maximum of 30 minutes the lungs tend to recoil make you feel vSim into existing curricula offers...