Fluids and Electrolytes Escape Room

FLUIDS AND ELECTROLYTES ESCAPE ROOM

SHANEKA DUMAS, BSN, RNFEBRUARY 27, 2023 ADVENTHEALTH UNIVERSITY

start

MISSION OBJECTIVES

• Recognize/analyze cues in clients with fluid/electrolyte imbalances.
• Prioritize plans for returning a client to homeostasis.
• Generate solutions and take action.
• Evaluate therapeutic response from treatment.

FLUIDS AND ELECTROLYTES REVIEW

QUESTS

MISSION OBJECTIVES

• What clinical manifestations are expected?
• What are the normal lab values?

• What clinical data is important vs. less important?
• What problem is important to manage first?
• What orders will be anticipated by the nurse?
• What intervention(s) are needed immediately?
• What interventions are needed next?

quests

Denise, a new medical-surgical unit nurse has just arrived for her first shift; she checks her watch for the time.

Denise, a new medical-surgical unit nurse has just arrived for her first shift; she checks her watch for the time.

Uh oh... she needs to clock in before her bedside report with Aaron.

0650

• Bed 3120: Schrute, D., BP 86/62 mmHg, HR 128, RR 32, had 110-mL urine output over 9 hours.

• Bed 2139: Hopper, J., BP 118/80 mmHg, HR 90, RR 26; diuretics ordered, reports dizziness when getting up.

• Bed 3123: Cooper, S., T 101.6; hematuria at every void.
• Bed 2125: Knope, L., BUN 34 mg/dL., creatinine 1 mg/dL; 200 mL of vomitus of undigested food 8 hours ago.

Bed 3123: T 101.6; hematuria at every void.

Bed 2139: BP 118/80 mmHg, HR 90, RR 26; diuretics ordered, reports dizziness when getting up.

Bed 2125: BUN 34 mg/dL., creatinine 1 mg/dL; 200 mL of vomitus of undigested food 8 hours ago.

Which patient should Denise see first?

Bed 3120: BP 86/62 mmHg, HR 128, RR 32, had 110-mL urine output over 9 hours.

Postrenal Failure

Ascites

Denise considers that the urine output is less than 30 mL/hr and Mr. Schrute's vital signs and prepares to carry out interventions for which medical diagnosis...

Hyponatremia

Intrarenal Failure

Prerenal Failure

quests

0743

Denise needs some additonal information; she needs a computer. Help her unlock the door to the supply room...

Vital Signs

Labs

Nurses' Notes

Orders

H&P

Schrute, D., 53 DOB: January 20, 1970 MRN: 1482928 Length of stay: 16 hrs

AlertsAllergies: Penicillin NPO Standard Precautions Covid: negative

Vital Signs

Labs

Nurses' Notes

Orders

H&P

C/C: 42-year-old male presents due to vomiting x 5 days. Treated with IV Zofran 2mg/mL, 1L NS bolus. Home meds: Furosemide 40mg PO qDay, Enalipril 20 mg PO qDay; OTC acetaminophen 500 mg PO PRN PHM: HTN x14 years; osteoarthritis x 5 yrs; No known renal disease or DM; penicillin allergy FH: Father died at age of 50 from CVA; mother has HTN Notes: Patient was admitted to medical surgical unit for observation.

Vital Signs

Labs

Nurses' Notes

Orders

H&P

2145: T= 98.5 oral; HR= 128 BPM, RR 32 bpm; BP= 88/60 mmHg; O2 Sat 96% on RA 2220: T= 98.7 oral; HR= 112 BPM, RR 24 bpm; BP= 92/74 mmHg; O2 Sat 98% on RA 2358: T= 98.6 oral; HR= 72 BPM, RR 12 bpm; BP= 115/80 mmHg; O2 Sat 100 % on RA 0300: T= 98.9 oral; HR= 98 BPM, RR 16 bpm; BP= 108/76 mmHg; O2 Sat 97 % on RA 0700: T= 98.7 oral; HR= 131 BPM, RR 30 bpm; BP= 86/62 mmHg; O2 Sat 95 % on RA

Vital Signs

Labs

Nurses' Notes

Orders

H&P

• The patient reports feeling nauseous
• IV discontinued @ 0000 r/t dislodgement of Right AC IV- no infiltration noted.
• The patient refused IV after 2 failed attempts
• Intake 150 ml of water
• Urine output 386 mL

Vital Signs

Labs

Nurses' Notes

Orders

H&P

ECG: Sinus tachycardia, rate 131 BM, no ST elevation Test Results Serum Sodium (Na) 148 mEq/L Serum potassium (K) 6.1 mEq/L Serum calcium (Ca) 11.1 mEq/L Serum Chloride (Cl) 108 mEq/L Glucose level 110 mg/dL Blood urea nitrogen (BUN) 27 mg/dL Creatinine (Cr) 2.8 mg/dL Specific gravity 1.037 White blood cells (WBC) 6000/mm3 Red blood cells (RBCs) 6.1 x 10*12/L Hemoglobin (HgB) 17.2 g/dL Hematocrit (Hct) 44.9%

Test

Normal

Low

High

Sodium (Na) 150 mEq/L

I need to figure out if my lab values are low, normal, or high....

Potassium (K) 6.1 mEq/L

Calcium (Ca) 12.3 mEq/L

Glucose 100 mg/dL

Blood urea nitrogen (BUN) 27

Specific gravity. 1.043

GFR 80 mL/min/1.73 m2

WBC 6.5 to 11.0 × 109/L

quests

Mr. Schrute is diagnosed with acute renal failure (ARF) related to dehydration. The health care provider (HCP) explains to Dwight the seriousness of his condition and the necessary treatment. Check the time and review the orders.

0800

Vital Signs

Labs

Nurses' Notes

Drug Guide

Orders

H&P

Vital Signs

Labs

Nurses' Notes

Orders

H&P

Drug Guide

0803

Select the orders Denise should question?

quests

3120

Denise enlists the help of Norma, the shift's charge nurse, to help with carrying out the corrected orders. Norma speaks with Dwight and he agrees to allow Denise to insert an IV. Make sure Denise foams in before entering room 3120.

Thanks for all the help! In order for Mr. Schrute to receive the appropriate interventions and discharge education, I need your help! Assess Mr. Schrute's for hydration status...

Mission Complete

Mr. Schrute is discharged! Help Denise clock out...

survey

https://www.surveymonkey.com/r/LJZWDS7

Next

references

Billings, D. M., & Hensel, D. (2020). Lippincott Q&A review for NCLEX-RN (Thirteenth ed.). Wolters Kluwer. LaCharity, L. A., Kumagai, C. K., & Bartz, B. (2019). Prioritization, delegation, and assignment: Practice exercises for the NCLEX examination (4th ed.). Elsevier. Silvestri, L. A., Silvestri, A. E., & Turchin, L. (2021). Saunders Q & A review for the NCLEX-RN examination (8th ed.). Elsevier.

exit

potential patient harm

try again