GUIDED SIMULATION

John Rogers, 55 y/o male, comes into the doctor’s office.  He called 2 hours ago to schedule an appointment because he was having difficulty swallowing.    He checks in with the receptionist and is shortly brought to the treatment room with the nurse.  The nurse starts to review his past medical history, verifies his current medications, and obtains his vital signs.   Past medical history: HTN, hyperlipidemia   Medications: atorvastatin 20 mg daily, lisinopril 20 mg daily   Vital Signs:   T   36.5o C HR 116 RR 28 BP 160/100 HT 6’0 WT 220 lbs   What would you think about these vital signs?
The nurse asks the patient why he is at the office today.  The patient reports he woke up this morning and felt like he was having a problem swallowing.  He further states he has never had this before.  The nurse proceeds with her assessment.  The patient denies pain or difficulty breathing.  He continues to say that he just feels like he has a lump in his throat.   You begin your assessment since you know the doctor is currently with another patient.
Based on what you have heard, is there anything you want to check right now?   
What is the priority intervention the nurse should take at this time?   
What would you anticipate will happen at this point?     
What should done next?       
What do you think is happening with this patient?   
Are you worried about this patient?  Why?      
Recap: You have administered lisinopril in the virtual clinical, and some of you have administered this at the clinical site.  In preparation for medication administration you are required to know the side effects and adverse reactions of the medications. During your medication administration, you would educate the patient on what side effects need to report to the physician and when to seek emergency treatment.    While this patient has been taking lisinopril for 18 months, this is a typical time a patient can develop an adverse reaction.  Angioedema is a true medical emergency as you can see.  If or when the patient’s airway has complete closure, the outcome will be undesirable.   
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