ACID-BASE ESCAPE ROOM

Acid-BaseEscape Room

NSG 310 Foundations of NursingNovember 20, 2023

start

Introduction

It is 2026, and you've secured your dream job as a float pool RN. You graduated from your nurse residency recently, and you are up for a new challenge. You loved your time at WCU so much you almost want to go back to nursing school! You would love to precept a senior student in practicum. You decide to really shine in the hopes of being picked to precept a student.

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Final Shift

Shifts

Complete each shift to beat the game: there is no other way to become a preceptor!

You are working in the ED today. A 77 year old woman from a nursing facility comes in with weakness and altered mental status. Her vital signs are: HR 114, BP 82/50, RR 24, SpO2 92%, T 102.6FWhat are your priority actions?

1/3

Collect labs and obtain an EKG

Collect labs and hang IV fluids

Collect labs and administer oxygen

Shift 1

Rationale

Labs should be collected on a patient with unstable vital signs. Especially with a fever, you would want to know a WBC count. With weakness and altered mental status, you need to be curious about electrolytes and general organ function. Labs are a must.IV fluids are a great choice for high HR, low BP, and weakness. We need to stabilize the cardiovascular system to keep perfusion to organs.An EKG may be part of a later workup, but with no symptoms of chest pain, it does not need to be an immediate action. Prioritize getting the BP stabilized and seeing what the labs reveal.Oxygen does not need to be immediately applied with an SpO2 of 92%.

As you go in to hang the IV fluids, you realize your patient is harder to arouse. You let the provider know and they add an arterial blood gas (ABG) order along with the other lab work. Meanwhile you start the IV fluids and continue to assess the patient. You realize the patient has a Foley catheter that was folded up under her legs. There is a small amount of dark, cloudy urine. A urine culture is ordered. How do you collect your sample?

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Remove the catheter and perform an I/O

Use the sample port from the tubing port

Replace the Foley catheter and pull off a sample from the tubing port

Shift 1

Rationale

If a patient arrives to the hospital with a chronic indwelling catheter, there is a reason it was originally placed. If you cannot determine when it was last placed and you need a urine sample for a culture, you would need to recath the patient. Since outpatient providers have determined she needed an indwelling catheter, we will need to replace the catheter for now.

Rationale

Using a sample port from a catheter that was not recently placed or replaced will not provide the best sample. Sampling from old tubing may gather bacteria that have colonized the tubing or bag. To get a more accurate sample from the bladder/urinary tract, the catheter needs to be new before drawing a sample from the tubing port.

Labs are back for your patient. ABG results:pH 7.14, PaCO2 28 mm Hg , HCO3- 14 mEq/L, PaO2 88 mm HgWhat is the disorder?

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Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Shift 1

Click on the correct answer to continue

pH 7.14, PaCO2 28 mm Hg , HCO3- 14 mEq/L

You must click the right answer (again) before getting the next question

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Final Shift

Shifts

Complete each shift to beat the game: there is no other way to become a preceptor!

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You work the next day in the ICU and the patient you admitted yesterday with urosepsis is assigned to you. You get report that the patient became delirious and agitated overnight and lorazepam was administered. During bedside shift change you find your patient very difficult to arouse. The provider is notified and an ABG is ordered.

Shift 2

You want to be able to explain the Allen's test to your future preceptee. You practice on your coworkers to make sure you have the technique down. Press the blue button after you watch the video.

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Next

Shift 2

The blood gas has resulted. pH 7.32, PaCO2 63 mm Hg, HCO3- 25 mEq/L, PaO2 87 mm HgWhat is the interpretation?

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Compensated respiratory alkalosis

Uncompensated Respiratory acidosis

Shift 2

Compensated respiratory acidosis

Partially compensated respiratory alkalosis

pH 7.32, PaCO2 63 mm Hg, HCO3- 25 mEq/L

You must click the right answer (again) before getting the next question

Shift 2

4/4

Click on the correct answer to continue

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Final Shift

Shifts

Complete each shift to beat the game: there is no other way to become a preceptor!

You come back the next day for another shift and you have the same patient assignment in the ICU. The patient remained in respiratory acidosis and has been on Bipap overnight. What is the rationale for this?

1/3

Improve hypoxia

Decrease respiratory rate

Increase ventilation

Shift 3

Watch this video:What settings on the Bipap will improve future ABGs with a patient in respiratory acidosis?

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Adjust FiO2 to improve oxygenation

Adjust respiratory rate to improve ventilation

Test 3

Advanced Topic!

How do you respond

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Bipap settings have been adjusted to increase ventilation (increasing respiratory rate and volume to assist with more CO2 being exhaled). There is another order for an ABG to assess effectiveness of interventions.

Shift 3

The patient's daughter is in the room and says the following. "I cannot stand for my mom to be poked and prodded, look how bruised she is! Didn't you already draw blood this morning?"

Role play with a peer to practice communication strategies to reassure the family member

Did you de-escalate the daughter?

Yes!

No

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Final Shift

Shifts

Complete each shift to beat the game: there is no other way to become a preceptor!

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It is another day in the Emergency Department. You are caring for a patient who had a witnessed seizure at home with no history of seizure disorder. This symptom is more likely to be a result of ____________ disorders.

Acidotic

Alkalotic

Shift 4

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Well done!Choose an ABG that shows partially compensated metabolic alkalosis

Shift 4

pH 7.51CO2 40HCO3- 28

pH 7.28CO2 40HCO3- 30

pH 7.48CO2 50HCO3- 30

pH 7.38CO2 30HCO3- 28

The patient wants to know why he had a seizure. What in his history makes you think why he developed a metabolic alkalosis that led to his seizure?

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Hypertension

Type 2 diabetes

Gastroesophageal reflux disorder

Insomnia

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Final Shift

Shifts

Complete each shift to beat the game: there is no other way to become a preceptor!

A rapid response is called on the med-surg floor and as an ICU nurse, you respond. The client is post-op day 2 after hip surgery to repair a fracture. He is on a high-flow nasal cannula on 10L, SpO2 86%. He is diaphoretic, clutching his chest and deeply breathing 34 breaths/min. If you drew an ABG, what results would you expect?

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pH 7.50, PaCO2 26, HCO3 26

pH 7.45, PaCO2 45, HCO3 22

pH 7.32, PaCO2 40, HCO3 20

Shift 5

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What diagnostic tests may you expect, knowing he is in respiratory alkalosis?

Shift 5

A chest CT to diagnose a pulmonary embolism

A head CT to diagnose a stroke

An EKG to diagnose a heart attack

A chest XRay to diagnose an asthma attack

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continuE

On a more thorough assessment, what additional symptoms may the patient be experiencing? (Respiratory alkalosis)

Experiencing

Not likely to experience

1. Dizziness

2. Bradycardia

3. Diarrhea

Solución

4. Edema

5. Tachycardia

SOLUTION

6. Extremity tingling

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Final Shift

Shifts

Complete each shift to beat the game: there is no other way to become a preceptor!

Annual Competency

1. For acid-base disorders, to correct the pH imbalance, interventions are aimed to treat the _____________ cause.

Your unit-based educator conducts an annual competency written test to assess knowledge and critical thinking. This helps them guide future education and learning activities.You sit down to take the exam and hope that a good score will prove you are ready to teach a senior WCU student.

+ info

Drag and sort correctly

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1

2

3

B. pH abnormal, CO2 and HCO3- abnormal

C. pH abnormal, CO2 or HCO3- abnormal

Final Shift

uncompensated disorder

compensated disorder

partially compensated disorder

A. pH normal, CO2 and HCO3- abnormal

continue

Solución

Solution

Drag and sort correctly

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1

2

3

4

continue

Solución

Solution

A. Lungs hypoventilate to retain CO2. Fast process.

B. Kidneys attempt to increase HCO3-. Takes hours to days

C. Lungs hyperventilate to rid body of excess CO2. Fast process.

D. Kidneys attempt to decrease HCO3-. Takes hours to days

Final Shift

respiratory acidosis

respiratory alkalosis

metabolic acidosis

metabolic alkalosis

Acid-Base Disorder

Compensation

Completed

Congratulations, you have successfully impressed your educator and manager!You are selected to be a preceptor and could not be more overjoyed at the thought of influencing the future of nursing!Click this link (hover & click the full screen/new tab option)to have another adventure!

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Click on the computer & find a resource you can save

back

That answer is not correct...

But don't lose your composure, continue on your way and try again!

Oh oh!

Go to your shifts ready to work and see if you can impress your manager and unit educator with your critical thinking skills!

genial.ly

Medications

What medication may the patient be taking to treat this disorder...What may reduce too much acid?

Medications

What medication may the patient be taking to treat this disorder...What may reduce too much acid?

You must correctly fill in the blank, this is your password to advance to the next exam question.

Try again

Although renal failure can cause metabolic acidosis, the patient presenting here has infection symptomsClick on the correct answer to continue

Medications

What medication may the patient be taking to treat this disorder...What may reduce too much acid?

With your peer's permission:

Practice Time!

Perform the Allen's test. Compare hands.Trade doing the activity with a peer

Try again

This is a partially compensated disorder. All the values are abnormal. The pH would have to be within normal range to be considered compensated.

1 = B

2 = D

3 = C

4 = A

Compensation

Compensated disorders have a NORMAL pH and abnormal PaCO2 and HCO3-Partially compensated have ALL abnormal pH, PaCO2 and HCO3-Uncompensated have abnormal pH and abnormal PaCO2 OR HCO3-

1 = C

2 = A

3 = B

Try again

Hyperventilation would result in lower CO2 levels and a respiratory alkalosisClick on the correct answer to continue

Experiencing

156

Not likely experiencing

234