pn 132 copd neoplasms respiratory meds. learning objectives define pathophysiology of common chronic...
TRANSCRIPT
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PN 132
COPD NEOPLASMS
RESPIRATORY MEDS
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LEARNING OBJECTIVES
• Define pathophysiology of common chronic respiratory disorders
• Discuss nursing interventions for patients with chronic respiratory disorders
• Define pathophysiology of malignant neoplasms (Lung Cancer) in the respiratory tract
• Discuss nursing interventions for patients with respiratory neoplasms
• Identify common respiratory medications
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Chronic Bronchitis
Asthma
Bronchiectasis
COPD
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WHAT IS COPD?• Progressive and irreversible
condition
• Diminished inspiratory and expiratory capacity of lungs
• Obstructs flow of air to or from the bronchioles – chronic airflow limitations
• Includes
• Emphysema
• Chronic bronchitis
• Asthma
• Bronchiectasis
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CHRONIC BRONCHITIS
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ETIOLOGY AND PATHOPHYSIOLOGY• Recurrent productive cough for minimum of 3 month / year for at least 2 years
• Caused by physical or chemical irritants and recurrent lung infections
• Cigarette smoking most common cause
• Other causes
• Workers inhaling dust (coal / grain)
• Underlying process
• Impairment of cilia (can’t move secretions)
• Mucous gland hypertrophy
• Causes hyper secretion alters cilia function
• Bronchial tubes become inflamed and scarred
• Patient cannot clear mucus becomes medium for bacteria
• Leads to bronchospasms
• Poor O2 / CO2 exchange increased CO2 in the blood
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CLINICAL MANIFESTATIONS• Productive cough
• Most pronounced in the morning
• Increased dyspnea
• Uses accessory muscles
• Cor Pulmonale
• Right side heart hypertrophy pulmonary hypertension
• Cyanosis
• Often accompanied by right ventricular failure
• Characteristic reddish-blue skin
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ASSESSMENT• Subjective
• Hx of smoking or exposure to irritants
• Family history of respiratory disorders
• Current medications and treatment regimen
• Objective• Assess productive cough
• Characteristics and amount of sputum
• Assess severity of dyspnea
• Note wheezing
• Patient’s level of restlessness and anxiety
• Monitor vital signs
• Tachycardia
• Tachypnea
• Elevated temp
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NURSING INTERVENTIONS• Hydration to liquefy secretions
• Suction prn
• Provide “low-flow” oxygen (1 – 2 L via nasal cannula)
• Maintain SpO2 > 90%
• Frequent oral hygiene
• Frequent rest periods
• Counsel about smoking cessation
• Assess
• Degree of dyspnea
• Use of sternal muscles for breathing
• Degree of fatigue
• Administer medications
Teach• Effective breathing
techniques• Avoid infection exposure• Notify MD at first sign of
respiratory infection• Changes in sputum
• Provide medication teaching
• Stress adequate fluid intake
• Encourage smoking cessation program
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ASTHMA
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• Wide spread narrowing of the airways
• Extrinsic
• Caused by external factors
• Pollen
• Dust
• Feathers
• Animal dander
• Foods
• Intrinsic
• Often triggered by respiratory infection
• Recurrence of attacks affected by
• Mental / physical fatigue
• Emotional factors
ETIOLOGY AND PATHOPHYSIOLOGY
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• Mild Asthma• Dyspnea with exertion
• Wheezing
• Symptoms usually controlled with medication
• Status Asthmaticus• Severe, life-threatening attack
• Does not respond to usual treatment
• Trapped air leads to exhaustion and respiratory failure
• Acute Asthma Attack• Usually happens at night
• Tachypnea
• Tachycardia
• Diaphoresis
• Chest tightness
• Cough
• Expiratory wheezing (caused by forcing air out)
• Use of accessory muscles
• Nasal flaring
• Increased anxiety
• Thick copious mucus
CLINICAL MANIFESTATIONS
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• Subjective• c/o anxiety
• Fear of suffocation
• Breathlessness
• Chest tightness
• Cough
• At night and early morning
• Objective• Assess s/s hypoxia
• Restlessness
• Inappropriate behavior
• Elevated pulse and B/P
• “hunched forward”
• Inspiratory and expiratory wheezes
• Thick stringy mucus
ASSESSMENT
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• Administer medications
• Ensure adequate fluid intake and optimal ventilation
• Rest with activity
• Elevate HOB
• O2
• Monitor vital signs
• Monitor electrolytes
• Empathetic emotional support!
• Teach • Effective breathing
• Lip-pursed breathing
• Correct use of peak flow meter
NURSING INTERVENTIONS
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BRONCHIECTASIS
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ETIOLOGY AND PATHOPHYSIOLOGY
• Abnormal / permanent dilation of one or more large bronchi
• Eventually destroys musculature and elastic support of bronchial wall
• Gradual loss of pulmonary muscle tone after repeated infections
• More difficult to clear mucus from the lungs
• Decreased expiratory air flow
• Occurs as complication of recurrent inflammation and infection
• Usually secondary to failure of normal lung tissue defenses
• Cystic fibrosis
• Foreign body
• tumor
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CLINICAL MANIFESTATIONS• S/S occur after respiratory infection
• Late S/S
• Dyspnea
• Cyanosis
• Clubbing fingers
• Coughing on arising in the morning and when laying down
• Copious amounts of foul-smelling sputum
• Fatigue
• Weakness
• Loss of appetite
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Subjective• Report of
• Difficulty breathing
• Weight loss
• Fever
Objective• Lung auscultation• Fine crackles and
wheezes in lower lobes
• Prolonged expiratory phase
• Increased dyspnea
• Hemoptysis (50%) of patients
ASSESSMENT
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• Cool mist vaporizer
• Increase fluid intake
• Assess vital signs and lung sounds q 2 – 4 h
• Suction prn
• Assist with coughing, deep breathing q2h
• Teach• Avoidance of
• Smoke
• Fumes
• Irritating inhalants
• Discourage smoking
• Rest with activity
• Medication teaching
• s/s of secondary infection
NURSING INTERVENTIONS
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NEOPLASMS
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LUNG CANCER
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ETIOLOGY / PATHOPHYSIOLOGY
• Leading cause of death from cancer in both men and women• Tumors -result from anywhere in the body -primary tumor -metastases from the colon and the kidney are common.
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ETIOLOGY / PATHOPHYSIOLOGY• 80-90% of lung tumors
• linked to cigarette smoking • passive smoking• breathing in side stream smoke
• Secondhand smoke• risk for the development of lung cancer in non-smokers
• History of smoking for 20 years or more
-prime risk factor for lung cancer
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• Occupational hazard risk factors• Asbestos• Radon• uranium
• Air pollution may also increase one’s risk.
• Mortality• specific type of cancer• size of the tumor when it is detected.
ETIOLOGY / PATHOPHYSIOLOGY
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TYPES OF LUNG CANCER
• Classified by microscopic study of the tumor• Treatment is specific to
• the type
• extent of the disease (staging)
• Tumor type and staging
• Small cell Ca (oat cell)
• Non small cell Ca
• Squamous cell Ca
• Large cell Ca
• Most people who develop the disease are older than 50
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• Pneumonectomy
• Removal of the entire lung
• Lobeectomy
• Removal of affected lung lobe
• Segmental resection
• Only a portion of the lung lobe is removed
• Radiation and Chemotherapy
• 1/3 are inoperable when first seen
• Surgical mortality
• 10% pneumonectomy
• 2 – 3% lobectomy
• Lobectomy and segmental resection requires chest tube insertion
MEDICAL MANAGEMENT
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CLINICAL MANIFESTATIONS
• Asymptomatic in the early stages• Lesion perforates the pleural space• Pleural effusion• Severe pain
• Central lesions • Obstruction• Erosion of the bronchus
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CLINICAL MANIFESTATIONS
• Cough
• Hemoptysis
• Fever
• Dyspnea
• Chills
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SUPERIOR VENA CAVA SYNDROME
• Invasion of the tumor into the superior vena cava
• edema of neck and face
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SUBJECTIVE • Chronic cough• Hoarseness• Weight loss • Extreme fatigue• Family history of
cancer• History of cigarette
smoking• Exposure to
occupational irritants.
OBJECTIVE • Cough
• Dry• hacking • Moist• factors that relieve the cough
• Sputum• Consistency• Amount • Frequency • Duration• Precipitating factors
• Auscultate the lungs• Unilateral wheezing• Crackles
ASSESSMENT
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NURSING INTERVENTIONS
• Whether treatment offers comfort or cure
• Patient needs comprehensive nursing interventions
• Consider:
• Patient’s quality of life
• Education
• Needed emotional support
• Symptom management.
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NURSING INTERVENTIONS – POST-OP
• Prevention of complications
• Effective airway clearance
• Frequent repositioning
• Cough/deep breathing
• Use of incentive spirometer
• Prevention of circulatory problems
• encourage exercise of legs and feet
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NURSING INTERVENTIONS• Oxygen• Vital signs• I&O• Pulse oximetry• Monitor labs• Repositioning• IV administration• Check patency of chest tubes if in use• Medication Administration• Analgesics• Antineoplastics• antiemetics
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PATIENT/FAMILY TEACHING
• Effective coughing techniques• Physical mobility• Nutrition -diet high in protein and calories -2000 mL of fluids per day (unless contraindicated)
• Discourage smoking
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PN 132
RESPIRATORY MEDICATIONS
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NASAL DECONGESTANTS
Adrenergics
• Ephedrine (Vicks)
• Oxymetazoline (Afrin)
• Phenylephrine (Neosynephrine)
Intranasal Steroids
• Beclomethasone dipropionate
• Beconase
• Vancenanse
• Flunisolide (Nasalide)
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ORAL DECONGESTANTS
• Prolonged effects
• Less potent
• No rebound congestion
• Exclusively adrenergics
• Example: Pseudoephedrine (Sudafed)
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TOPICAL DECONGESTANTS
• Adrenergics-Prompt onset
-Sustained use Rebound Congestion
• Both adrenergics and steroids
-Potent - work well
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NASAL STEROIDS
• Anti-inflammatory-Decrease inflammation-Relieve nasal congestion
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NASAL DECONGESTANTS: SIDE EFFECTS
Adrenergics• Nervousness
• Insomnia
• Palpitations
• Tremors
Steroids• Local mucosal dryness and irritation
• Candida infections
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DISORDERS TREATED WITHNASAL DECONGESTANTS
• Acute or chronic rhinitis• Common cold• Sinusitis• Hay fever• Other allergies
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NASAL DECONGESTANTS NURSING IMPLICATIONS
• Avoid decongestants in the following clients:• Heart disease
• Hypertensive disease• Respiratory Disease
• Assess for drug allergies
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BRONCHODILATORS
• Can be aerosolized to relax and open the bronchial airways.
• Can treat several disease syndromes
• COPD
• Asthma
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BRONCHODILATORS
• Classes of Bronchodilators:
• Sympathomimetic Agents
• Xanthine Bronchodilators
• Anticholinergics
• Leukotriene Receptor Antagonists
• 5-lipoxygenase inhibitors
• Mast Cell stabilizers
• Corticosteroids
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BRONCHODILATOR ADMINISTRATION
• Use of an Inhaler• MDI (Multi-dose inhaler) is also called a rescue inhaler,
it delivers a puff of medication that is inhaled.
• Nebulizer dispenses a larger dose of the bronchodilator over a longer duration in the form of a mist that is breathed in.
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SYMPATHOMIMETIC AGENTS
• Examples:• Epinephrine
• Isoproterenol (Isuprel)
• Albuterol
• General Side Effects:• Nausea, increased anxiety, palpitations, tremors, and
increased heart rate
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SYMPATHOMIMETIC AGENTS
• Uses:
• Treat acute asthmatic attacks as well as prevent attacks
• Quickly reduces airway constriction and restore normal airflow
• Relief of bronchospasm, bronchial asthma, bronchitis, etc.
• Treat hypotension and shock
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XANTHINES• Chemical class of agents that contain caffeine
• Oldest class of bronchodilators – used in ancient times
• Mechanism of Action• Increase levels of energy producing cAMP
• Inhibits phosphodiesterase
an enzyme that breaks down cAMP
• Results: smooth muscle relaxation; Broncho dilation; increased airflow
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XANTHINES – SIDE EFFECTS
• Adverse reaction: cardiac life-threatening side effect
• Xanthine Derivatives
• Side Effects:• Nausea, vomiting, anorexia
• GERD during sleep
• Sinus tachycardia, extra systole, palpitations, ventricular derivatives
• Transient increase urination
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ANTICHOLINERGICS• Actions: • Local effects
• Slow and prolonged
• Used to prevent bronchospasm
• Not used for acute asthma exacerbations
• Examples:
• Ipratropium bromide (Atrovent)
• Tiotropium Bromide (Spiriva Handihaler)
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ANTICHOLINERGICS: SIDE EFFECTS• Usually not absorbed systemically
• If absorbed, have the potential to produce:• Dry mouth
• GI distress
• Headache
• Coughing
• Anxiety
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LEUKOTRIENE RECEPTOR ANTAGONISTS
• Directly prevent bronchospasm
• Developed to treat asthma
• Leukotrienes:• Are inflammatory molecules
• Released by mast cells
• Causes bronchioles to contract
• Can cause development of edema in the lungs
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LEUKOTRIENE RECEPTOR ANTAGONISTS
• Currently available agents:• Montelukast (Singular)
• Zafirlukast (Accolate)
• Side Effects:• Headache
• Nausea
• Diarrhea
• Liver dysfunction
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LEUKOTRIENE RECEPTOR ANTAGONISTS
• Client Education:
• Use for chronic management of asthma – not acute episodes
• Improvement should be seen in about 1 week
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5-LIPOXYGENASE INHIBITORS• New class
• Inhibit the formation of leukotrienes
• Used to inhibit some cancer growth
• Use: prevent lung infection
• Example: Zileuton
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MAST CELL STABILIZERS
• Used prophylactically
• No direct Broncho dilation activity
• Indirect action
• Stabilizes the cell membranes of the inflammatory cells – mast cells, monocytes, macrophages• Prevents the release of harmful
cellular contents
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MAST CELL STABILIZERS
• Acts as an adjunct to overall management of clients with lung disease
• Prevents bronchospasm when exposed to:• Cold air
• Exercise
• Allergens
• Dry air
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MAST CELL STABILIZERS
• Examples:
• Cromolyn (Nasalcrom, Intal)
• Nedocromil (Tilade)
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CORTICOSTEROIDS
• Inhaled Corticosteroids:• Anti-inflammatory
• Inhaled forms reduce systemic effects
• Treatment of chronic Asthma - does not relieve acute asthma
• Stabilize membranes of cells that release harmful broncho-constricting substances
• Increases responsiveness of bronchial smooth muscle to beta-adrenergic stimulation
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CORTICOSTEROIDS• Examples:
• Beclomethasone dipropionate (Beclovent, Vanceril)
• Tramcinalone acteonide (Azmacort)
• Flunisolide (AeroBid)
• Combination Products:• Advair – fluticasone + salmeterol; dry
powder in circular diskus
• Salmeterol – long acting bronchodilator
• Corticosteroid – anti-inflammatory agent; used daily
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EXPECTORANTS
• Drugs that aid in the expectoration (removal) of mucous
• Reduce the viscosity of secretions
• Stimulates the flow of respiratory secretions
• Note: Secretions – by loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished.
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EXPECTORANTS: SIDE EFFECTS
• Common side effects:• Guaifenesin
• Nausea, vomiting
• Gastric irritation
• Terpin hydrate• Gastric upset (elixir has high alcohol
content)
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EXPECTORANTS: NURSING IMPLICATIONS
• Use with caution in the elderly
• Encourage client to drink fluids• Monitor for therapeutic effects.• Report a fever lasting longer than a week.
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ANTITUSSIVES
• Cough Relief
• Used to relieve nonproductive coughs associated with:• Pertussis Common colds
• Bronchitis Laryngitis
• Sinusitis Influenza
• Pharyngitis
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ANTITUSSIVES
• Drugs used to control coughing• Opioids and non-opioids• Narcotics•Used for nonproductive coughs
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OPIOID ANTITUSSIVES
• Suppress the cough reflex by direct action on the cough center in the medulla• Example: codeine + guiafenesin =
Robitussin AC
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NON-NARCOTIC ANTITUSSIVES
• Dextromethorphan• Suppresses the cough reflex in the cough center in the
medulla; a chemical derivative of the opiate narcotics
• Result: diminished cough
• Produces no respiratory depression, analgesia, or dependence
• Example: Robitussin-DM
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ANTITUSSIVE AGENTS: SIDE EFFECTS
• Benzonatate (Tessalon Pearls)
• Dizziness, headache, sedation
• Dextromethorphan
• Dizziness, drowsiness, nausea
• Opioids
• Sedation, nausea, vomiting, lightheadedness, constipation
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ANTITUSSIVE AGENTS: NURSING INTERVENTIONS
• Perform respiratory assessment• Instruct clients to:• Avoid driving or operating heavy equipment
• Do not drink liquids for 30 to 35 minutes after taking a cough syrup or using a cough lozenge
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ANTITUSSIVE AGENTS: CLIENT TEACHING
• Report any of the following symptoms to the health care professional:• Cough that lasts more than 2 weeks
• A persistent headache
• Fever
• Rash
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SUMMARY• Defined pathophysiology of common chronic respiratory
disorders
• Discussed nursing interventions for patients with chronic respiratory disorders
• Defined pathophysiology of malignant neoplasms (Lung Cancer) in the respiratory tract
• Discussed nursing interventions for patients with respiratory neoplasms
• Identified common respiratory medications
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ASSIGNMENT• Read and Review
• AHN - Chapter 9
• Pp. 420 – 430 (Chronic Respiratory Disorders)
• Pp. 413 – 415 (Lung Cancer)
• Pp. 401 – 403 (Respiratory Medications)
• *** Finalize Mid-Term Paper (Due Day 6)
• Be sure to keep a copy!
• Review for Quiz 2 (chronic respiratory disorders / neoplasms / respiratory meds)
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NEXT CLASS• **Quiz 2 – Proctored Open-Book Exam (5% of
course grade) verses ATI: Pharmacology 3.0
• Covers Day 5 material
• Begin Group Projects
• Investigating and identifying project resources
• Establish project responsibilities
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QUESTIONS?