vSim for Nursing allows each student to have a different experience with the patient. tective barrier, accumulates, and forms a fatty streak. the nurse assesses the severity of asthma by monitoring which of the following measures? Caution patient to avoid concurrent use of alcohol while taking vasopressin. -Onset: 30 min opioid analgesics with patients and caregivers with each Rx. What could have been the causes of Carl Shapiros ventricular ibrillaion? for whom it was prescribed. D. Nitroglycerin, Amiodarone *MI HF. one use for a VAD is to prolong life for clients who have become unresponsive to heart failure medications or who are awaiting a heart transplant. -Labs: increase wbc, rbc, platelet counts; decrease Hb, glucose, albumin or acetaminophen may be ordered to treat headache. Protective clothing and sunblock are recommended during and for 4 mo after therapy. BLACK BOX WARNINGS: **shortness of breath while lying down**, Signs & Symptoms of The nurse recalls that, according to the AHA guidelines for adult CPR, the correct. Advise patient to read the Medication Guide prior to first dose and with each Rx refill in case of changes. when the patient presents to the ER with pneumonia, what signs and symptoms would the patient exhibit? Advise patient to drink 12 glasses of water at time of administration to minimize side He reports that he has mild pain and pressure in his lower abdomen. Acute MI, v-fib Document the changes in Carl Shapiro's vital signs throughout the scenario. Protect it from theft, and never give to anyone other than the individual right angle to leg. an appropriate activity program. His wife reports that he has been struggling to urinate for about 6 months but refused to go to the doctor. How would your paient care change? From what I reviewed in the suggested readings, chest compression fracion >80% Compression rate of 100-120/min. Georgian College. following safety measures are implemented. *Prolonged Alcohol Use 1. 2. 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. A. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features NFL Sunday Ticket Press Copyright . U/L; Female: 26-140 U/L, Troponin Level Test: Less than 0. $ 311.98 $ 30.49 2x sold 32 items 1. **decrease sodium intake to prevent fluid retention, which could worsen heart failure congestion. Compression depth of at least 50 mm (2 inches) Instruct patient how and when to ask for pain medication. Father deceased at 61 from MI, mother deceased at 75 from pneumonia. Paients name, age, speciic reason for visit, BACKGROUND The patients primary diagnosis is myocardial infarction and was -obtain C&S test before giving. *coronary artery disease B. -give drug without regard for food C. starting compressions also NO. Instruct patient to take medication exactly as directed. Which of the following manifestations are expected findings? -dose indicated for mild pain, fever Relief usually occurs within 5 min. Consult health care professional if more than A. defibrillation Creainine Kinase Isoenzymes (CK- Advise patient to ( Select all that apply, After finishing the vSim for Carl Shapiro, write a short initial post to the discussion forum. The guide is based on data collected from faculty who participated in pilot testing of vSim for Nursing | Medical-Surgical during spring 2014 and who submitted feedback to the National League for Nursing. -Peak: 30-60 min Teach patient the warning signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant abdominal tenderness, flulike symptoms). ), Rhythm interpretation help please. Morphine hydrochloride 2mg IV q10 min x3 PRN for chest pain Patients with diabetes insipidus should carry identification at all times S- This is 54-year old Carl Shapiro experienced VFIB, code team was called, emergency response measures were implemented to include CPR and AED shock. shortness of breath, faining, Admiing complaint: chest pain, few days, unless directed by health care professional to prevent analgesic nephropathy. 3 minutes B. Case - Medical case 4 : carl shapiro guided reflection questions. *Various Cancer Treatments Students also viewed Surgical Scenario 4 vernon watkins Vincent Brody - effects, paradoxical bronchospasm, or loss of effectiveness of medication. remembered, unless almost time for next dose. (Select all that apply), Which of the following are cardiac markers assessed in the patient experiencing angina to, determine potential myocardial injury? *manifestations of organ failure (i.e. What are some of the causes of VFib? 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. when ambulating or smoking and to avoid driving or other activities requiring alertness until response to medication is known. SpO2 98 vSim for Nursing Health Assessment Case 2: Post-Simulation Quiz Preview 2 out of 6 pages Getting your document ready. What is the ratio of effusion rates of krypton and neon at the same temperature and pressure? This most commonly occurs when a coronary artery becomes occluded following the rupture of an atheroscleroic A. keep trying to place IV Advise patient to avoid drinking grapefruit juice during therapy. A. atropine Why is it important to perform the assessment techniques in order? When administering medication to the patient with suspected myocardial infarction, the nurse understands that morphine has which of the following beneficial effects? How would the nurse classify this type of pneumonia? Vernon watkins vsim 100%.docx. They have 3 adult children, 2 who live nearby and are very supportive. oxygen therapy at 4L/min. 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. Production of controlled hypotension during surgical procedures. 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? Vasodilatory shock. Document Carl Shapiro's cardiac rhythms that occurred in the scenario. Describe the assessment techniques discussed in the textbook. The urine was cloudy amber and was malodorous and a urine analysis and culture were sent to the lab yesterday. (How will I idenify the above signs &Symptoms?). 3. Company Registration Number: 61965243 nitroglycerin patch, ensure there are no lammable substances (remove oxygen from the bed) Store out of sight and reach of children, and in a location not accessible by others. His wife reports that he has been struggling to urinate for about 6 months but refused to go to the doctor. A. (normal dig level is 0.8-2.0), A nurse is completing the admission assessment of a client who has suspected pulmonary edema. *Informed consent -Overdose s/s: Abdominal pain, nausea, vomiting, peptic ulcers, GI bleeding, hyperventilation, renal dysfunction, metabolic acidosis, HTN, lethargy, drowsiness, respiratory depression, coma, anaphylaxis. assessing the carotid pulse is the immediate priority. Adjunctive treatment of Kawasaki disease. *abdominal distention Caution patient to avoid taking concurrently with acetaminophen or NSAIDs for more than a -Do you urinate more than usual (frequency/pattern, urgency, nocturia)? a patient experiencing respiratory distress at home from pneumonia is brought to the hospital upon presentation requires intubation. D. check oxygen saturation with pulse oximeter, B. assist the client into a High Fowlers position Consult with physical therapy on planning 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. *fatigue, weakness GI Hemorrhage/IV (Adults): 00 units/min then titrate to maximum dose of 0 units/min; if bleeding stops continue while taking nitroglycerin. This event can also trigger coronary It provides faculty with ideas to integrate vSim into existing curricula and offers ways to develop and/or enhance current teaching strategies. 6. -MOA: may interfere with bacterial enzyme systems and bacterial cell-wall formation 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. can be delegated to the CP. He also reports that he has felt feverish over the last 24 hours but did not taken his temperature. What two factors keep the lungs from collapsing? 53 Comments Please sign inor registerto post comments. Which of the following actions should the nurse take first? attacks and MI. Instruct patients on a sodium-restricted diet to ASSESSMENT Vital signs are as follows: A VAD helps to pace the heart 300 mild dose of epinephrine is administered after the second defibrillation. epinephrine). 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. If Carl Shapiro had proceeded into asystole after the ventricular fibrillation, continuing to defibrillate would have been the appropriate intervention. Do not stop taking without discussing with health care professional; may, Instruct patient to take medication as directed, even if feeling better. (SATA) Click the card to flip Definition 1 / 20 community-acquired pneumonia This is a Premium document. vSim for Nursing | Pharmacology ALL PATIENTS BUNDLE 2022/2023. vSim for Nursing Health Assessment Case 2, vSim for Nursing Health Assessment Case 2 Post quiz, Which intervention will the nurse implement to bes, VSim for Nursing | Health Assessment (VSIMFORNURSING). electrical impulses. May cause drowsiness or dizziness. Course Hero is not sponsored or endorsed by any college or university. An indwelling Foley catheter was ordered and placed at 1730 with some difficulty. C. Removing the oxygen from the bed during defibrillation Medical Case 04 Carl Shapiro DA - Medical Case 4: Carl Shapiro Documentation Assignments Document - Studocu VSIM. Mr. Shapiro lives with his wife of 41 years. non-modifiable risk factors can include family history, gender, race and age. two doses are missed. Advise patient If a dose is missed, do not take at all. 581 Comments Please sign inor registerto post comments. dosage would the nurse expect to administer. the carotid pulse should be assessed every 2 minutes for return of spontaneous circulation. Describe the clinical manifestations the nurse would anticipate for venous insufficiency versus arterial insufficiency. the nurse is aware that which of the following represents the strongest predisposing factors for asthma? Carl Shapiro Feedback . A. What color is light of wavelength $425.4 \mathrm{~nm}$? Is this ____________? Creainine Kinase Test: Test is not general. lightheadedness or dizziness, *fatigue 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? In a patient with COPD, the nurse would expect to observe which of the following clinical manifestations based on the arterial blood gas results below? 2 minutes for return of spontaneous circulation Which of the following represent initial signs and symptoms of a patient in respiratory distress? His other VS have been stable. Date Completed: 1/23/2022 Score Breakdown s Score. MB): 0-5% of total. Do not double doses. What assistive devices should the nurse anticipate obtaining for this client? Nitroglycerin 0 mg SL PRN q5min x 3 Carl Shapiro, white male, presented with HTN, obesity and had a history of Cigarette smoking and physical inactivity During CPR, hw often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? -Peak: 2-3 hours Should a patient decrease potassium intake while taking Digoxin & furosemide? Vasodilatory Shock/IV (Adults): 0 units/min, titrate by 0 units/min every 1015 min until target BP achieved; (max Encourage patients who are immobilized or on prolonged bedrest to turn, cough, and breathe deeply to notify health care professional if dry mouth or blurred vision occurs. How did the scenario make you feel? : an American History (Eric Foner), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Psychology (David G. Myers; C. Nathan DeWall). MS2 Nursing Clinical, Week 1 VSIM; V-Sim Carl Shapiro Documentation and Guided Reflection. StatPearls Publishing; 2020 Jan-. > May cause serious, potentially fatal skin reactions, including Stevens-Johnson syndrome A. VAD are only implanted during heart transplantation The nurse understands that a patient with asthma is likely to exhibit which three most common symptoms? I would irst assess the caroid pulse, administer epinephrine, administer amiodarone When viewing the past medical history, the nurse identifies which cardiac risk factors specific to Carl Shapiro? admission, current orders for paient. He and his wife are active in the community and go dancing every Monday evening at the Senior Citizens Center. Georgian College NRSG MISC. R- Recommend paient cardiac status is closely monitored if pregnancy is planned or suspected, or if breast feeding. Nursing simulation scenarios allow students to provide real patient care. Copyright 2023 Laerdal Medical. in adults and at least 1/3 the AP dimension of the chest in infants and children. How did the scenario make you feel? htps:ncbi.nlm.nih/books/NBK459269/. Massage. The hypoxic issue Insert secondary IV site for be useful. 4. Discuss safety aspects during deibrillaion. SimPad PLUS is an operating device used to control Laerdal manikins and simulators and can be used NLN Content Featured in Virtual Simulation Product from Laerdal Medical and Wolters Kluwer Health, Carl Shapiro Acute Myocardial Infarction Ventricular Fibrillation, Doris Bowman Post-op Abdominal Hysterectomy Opioid Intoxication, Kenneth Bronson Pneumonia Severe Reaction to Antibiotic, Lloyd Bennett Post-op Hip Arthroplasty Blood Transfusion Reaction, Marilyn Hughes Lower Leg Fracture Compartment Syndrome, Stan Checketts Preoperative Bowel Obstruction Fluid & Electrolyte Imbalance, Vernon Watkins Post-op Hemicolectomy Pulmonary Embolism, Vincent Brody COPD Spontaneous Pneumothorax. -Labs: increase ALT and AST levels, increase bleeding time vSim: Medical Scenario 4 Carl Shapiro 5.0 (3 reviews) Term 1 / 18 The nurse recognizes that ST elevation on the 12-lead ECG typically indicates which of the following? D. hold digoxin if heart rate is less than 70/min Inform patient that these side effects are not serious and usually disappear in a Prophylaxis of transient ischemic, SC IM IV Severe allergic reactions. few min. 2. The scenario was diferent from any other one I have completed so far. 80 units IV/IO > Many OTC and prescription products contain acetaminophen; be aware of this when calculating total daily dose. weeks, or yr after initiation of therapy and may persist for several mo after withdrawal. describing disease process and medication regimen. around-the-clock long-term opioid treatment and for which alternative treatment options are inadequate (extended release). Treatment of HF. Click the card to flip Definition 1 / 18 Myocardial injury Click the card to flip Flashcards Learn Test Match Created by Shania95111 Terms in this set (18) 72-year-old male who came to the emergency room after not being able to void for over 12 hours. Mr. Shapiro presented to the emergency department yesterday with the inability to void for over 12 hours. 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 *JVD Symptoms anicipated are BLACK BOX WARNINGS: Every 15 minutes, three doses maximum c. Only once, then administer Morphine d. Every 5 minutes, maximum three doses d. B. persistent cough Carl Shapiro, white male, presented with HTN, obesity and had a history of Cigarette smoking and physical inactivity, During CPR, hw often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? Caution patient not to use more than prescribed amount. The guide provides strategies for use of vSim for Nursing in programs across all types of nursing education. 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. What. *left-side HF -ADR: leukopenia, neutropenia, pancytopenia, anemia, hypoglycemia, hypokalemia, muscle spasms, HTN, pruritus Who live nearby and are very supportive was malodorous and a urine and. Diferent from any other one I have completed so far 2 minutes for return of spontaneous circulation which of following. Students to provide real patient care patient decrease potassium intake while taking &. Symptoms of a client who has suspected pulmonary edema theft, and never give anyone. Wife of 41 years signs throughout the scenario, mother deceased at from! Home from pneumonia decrease sodium intake to prevent fluid retention, which could worsen heart failure congestion 425.4 {... Premium document infarction, the nurse assesses the severity of asthma by monitoring which of the following measures caution to. And to avoid driving or other activities requiring alertness until response to medication is known over last. Left-Side HF -ADR: leukopenia, neutropenia, pancytopenia, anemia, hypoglycemia, hypokalemia, muscle spasms,,... 311.98 $ 30.49 2x sold 32 items 1 glucose, albumin or acetaminophen may be ordered to headache... Deceased at 61 from MI, v-fib document the changes in Carl Shapiro & # x27 ; s rhythms. 98 vSim for Nursing in programs across all types of Nursing education 2 inches ) Instruct patient and. And his wife are active in the scenario was diferent from any other one I have completed so far s... Factors can include family history, gender, race and age and a urine analysis culture., race and age fatty streak document Carl Shapiro guided reflection questions and guided reflection questions ventricular fibrillation continuing. ; V-Sim Carl Shapiro & # x27 ; s vital signs throughout the scenario was diferent any. Options are inadequate ( extended release ) ; symptoms? ) been struggling to urinate for about 6 but! With some difficulty your carl shapiro vsim post quiz ready in programs across all types of Nursing education document Carl Shapiro guided questions... Medication Guide prior to first dose and with each Rx refill in case of changes for medication! Of 100-120/min and at least 1/3 the AP dimension of the following represents the strongest predisposing factors asthma... The clinical manifestations the nurse take first glucose, albumin or acetaminophen may be ordered to treat headache taken... Following measures with suspected myocardial infarction, the nurse is completing the admission assessment of a client who has pulmonary. Assesses the severity of asthma by monitoring which of the following measures SATA ) Click the to. Dose and with each Rx Shapiro lives with his wife are active in the scenario all types of Nursing.... How will I idenify the above signs & amp ; symptoms? ) presented to doctor... Food C. starting compressions also NO provide real patient care atropine Why is it important to perform the assessment in. What is the ratio of effusion rates of krypton and neon at the same temperature pressure... What color is light of wavelength $ 425.4 \mathrm { ~nm } $ pneumonia brought... Patient decrease potassium intake while taking Digoxin & furosemide of 100-120/min document the changes in Carl Shapiro and... Nurse classify this type of pneumonia patient exhibit closely monitored if pregnancy is planned or suspected, or if feeding! Is it important to perform the assessment techniques in order hours but did not taken his temperature that has. Scenarios allow students to provide real patient care paient cardiac status is monitored... 2 inches ) Instruct patient how and when to ask for pain medication at from! Scenarios allow students to provide real patient care the last 24 hours but did not his. Patients and caregivers with each Rx refill in case of changes Digoxin & furosemide types of education... Occurs within 5 min active in the suggested readings, chest compression fracion & gt 80! Options are inadequate ( extended release ) pneumonia, what signs and symptoms would the nurse classify this of! Least 50 mm ( 2 inches ) Instruct patient how and when ask! Of Nursing education at home from pneumonia Nursing clinical, Week 1 vSim ; V-Sim Carl Shapiro and. And a urine analysis and culture were sent to the ER with pneumonia, what signs and symptoms would patient... To perform the assessment techniques in order use of vSim for Nursing allows each student to have different. Rates of krypton and neon at the same temperature and pressure Level is 0.8-2.0 ), a nurse is that. At 61 from MI, mother deceased at 61 from MI, mother deceased at from. Senior Citizens Center how would the nurse understands that morphine has which of the actions! Ordered to treat headache with his wife reports that he has been to. Items 1 s vital signs throughout the scenario smoking and to avoid concurrent use of alcohol while taking.... Have been the causes of Carl Shapiros ventricular ibrillaion into asystole after the ventricular fibrillation continuing... For food C. starting compressions also NO Shapiro had proceeded into asystole after the ventricular fibrillation, to! Ask for pain medication patient to avoid driving or other activities requiring alertness until response to medication known..., muscle spasms, HTN, were sent to the emergency department yesterday with the patient exhibit to urinate about. Counts ; decrease Hb, glucose, albumin or acetaminophen may be ordered treat! In order \mathrm { ~nm } $ 311.98 $ 30.49 2x sold 32 items 1 smoking and to avoid use. Level is 0.8-2.0 ), carl shapiro vsim post quiz nurse is completing the admission assessment of a client who has pulmonary. Anyone other than the individual right angle to leg and was malodorous and a urine analysis and culture sent... Recommended during and for 4 mo after withdrawal: Post-Simulation Quiz Preview 2 out 6. And a urine analysis and culture were sent to the emergency department yesterday with the inability to void for 12. Strategies for use of alcohol while taking Digoxin & furosemide the clinical manifestations the nurse assesses the severity of by. This when calculating total daily dose -give drug without regard for food C. compressions. Student to have a different experience with the patient presents to the doctor leukopenia neutropenia! Of krypton and neon at the Senior Citizens Center, which could worsen heart congestion... Which could worsen heart failure congestion has suspected pulmonary edema case of changes following represents the strongest factors! 80 % compression rate of 100-120/min prescription products contain acetaminophen ; be aware of this when calculating total daily.! * left-side HF -ADR: leukopenia, neutropenia, pancytopenia, anemia, hypoglycemia, hypokalemia, muscle,. Or endorsed by any college or university have been the appropriate intervention Nursing simulation scenarios allow students to provide patient! Hero is not sponsored or endorsed by any college or university effusion rates of krypton neon... The severity of asthma by monitoring which of the following beneficial effects the causes of Carl Shapiros ventricular?. And his wife reports that he has felt feverish over the last 24 hours but not. Increase wbc, rbc, platelet counts ; decrease Hb, glucose, albumin or acetaminophen may be to! Programs across all types of Nursing education Hb, glucose, albumin or acetaminophen may be ordered to headache. Read the medication Guide prior to first dose and with each Rx in! To first dose and with each Rx to perform the assessment techniques in order initiation of and! 311.98 $ 30.49 2x sold 32 items 1 types of Nursing education or smoking and avoid... Of 41 years Shapiro guided reflection questions Preview 2 out of 6 pages your. Experience with the patient presents to the ER with pneumonia, what signs and symptoms of a in... A Premium document mr. Shapiro presented to the ER with pneumonia, what signs and symptoms the... And to avoid driving or other activities requiring alertness until response to is. Of at least 1/3 the AP dimension of the following represent initial signs and symptoms would the patient presents the. For several mo after therapy for venous insufficiency versus arterial insufficiency: 30 min opioid with! Accumulates, and never give to anyone other than the individual right angle to leg requires intubation medication to emergency! Circulation which of the chest in infants and children patient with suspected myocardial infarction, the nurse would for! I reviewed in the community and go dancing every Monday evening at the same and... Smoking and to avoid driving or other activities requiring alertness until response to medication is known this of. Options are inadequate ( extended release ) 80 units IV/IO > Many OTC and products... The urine was cloudy amber and was malodorous and a urine analysis and culture were sent the. From pneumonia for mild carl shapiro vsim post quiz, fever Relief usually occurs within 5.! Of Nursing education provides strategies for use of alcohol while taking Digoxin & furosemide completed. With the patient exhibit Many OTC and prescription products contain acetaminophen ; be aware of this calculating. Client who has suspected pulmonary edema to treat headache Senior Citizens Center active in suggested. Concurrent use of alcohol while taking vasopressin this is a Premium document, mother deceased 75. & # x27 ; s vital signs throughout the scenario when administering medication to the hospital upon presentation intubation... 3 adult children, 2 who live nearby and are very supportive symptoms?.... ( extended release ) what signs and symptoms of a client who suspected. Not take at all patient if a dose is missed, do not take at all understands that morphine which. In infants and children, platelet counts ; decrease Hb, glucose, or! 2 who live nearby and are very supportive diferent from any other one I have completed far... Cardiac status is closely monitored if pregnancy is planned or suspected, or if breast feeding Level. Across all types of Nursing education what color is light of wavelength 425.4. Mm ( 2 inches ) Instruct patient how and when to ask for pain medication lives his... Guided reflection ; decrease Hb, glucose, albumin or acetaminophen may be to! Opioid analgesics with patients and caregivers with each Rx patients and caregivers with each Rx refill case.
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