NSG 310 Great Escape

Exam 3 Content

The Great Escape

start

The following activity will walk you through Bowel Elimination content and Intake and Output calculations.

Click the arrow when ready

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Final Test

Test 4

Test 5

Test 1

The client is a 62-year-old presenting to the provider’s office for an annual check-up. The client has a history of hypertension, atrial fibrillation, and diabetes mellitus. Upon examination, the client tells you that they have been having black tarry stools. What problem do you believe the client has?

Lower gastrointestinal bleed

Upper gastrointestinal bleed

The answer to the last one was upper GI bleed. In order to continue on to the next part of the case you have another question to answer related to Bowel Elimination to get back on track

Newborn and Infant Meconium Stool color dependent upon type of milk ingested Frequent and multiple bowel movements a day Toddler and Preschooler Duodenocolic reflex Toilet training after 22 months

School-age child and Adolescent Bowel function reaches adult standard Peer pressure may contribute to constipation Adult and Older Adult Bowel movement frequency decreases, GI motility slows Increased fluid and fiber in diet

When you are ready to continue with the case, press the red arrow to the right. You are continuing with the assumption that the patient may have an upper gastrointestinal bleed.

Test 1

What types of medications could the client be taking that could contribute to this problem?

Antibiotics

Anticoagulants

Antiarrhythmics

Test 1

On lab results, what value would you consider a priority to check with an upper gastrointestinal bleed?

Platelets

Creatinine

Hemoglobin

Potassium

That last one was incorrect. Let us do a matching activity to better understand the 4 lab values. Drag the description underneath the lab it describes then click solution to see the results (Solution button shows up after 15 seconds. The continue button shows up after 45 seconds).

1. Lab that indicates red blood cells attached to oxygen. Low value would lead to hypotension, tachycardia, and shock.

Platelets

Creatinine

2. Electrolyte important for muscle, cell, and heart functioning. Low and high values lead to heart conduction issues.

3. Lab value related to the ability to clot. Low values mean the blood does not clot as well.

Potassium

Hemoglobin

4. Lab value that corresponds to kidney function.

continuE

Solución

SOLUTION

Test 1

What type of lab order do you anticipate the provider ordering?

Fecal occult blood test

Stool culture sample

Test 1

Is there a specific procedure you anticipate the provider ordering based off the scenario information?

Esophagogastroduodenoscopy (EGD)

Colonoscopy

Tests

Complete each test to beat the game: there is no other way to escape!

Test 2

Test 1

Test 3

Test 5

Final test

Test 4

Test 1

The client is a 62-year-old presenting to the provider’s office for an annual check-up. The client has a history of hypertension, atrial fibrillation, and diabetes mellitus. Upon examination, the client tells you that they have been having frequent loose stools for several days. What gastrointestinal problem do you anticipate based on that information?

Diarrhea

Constipation

Test 1

What effect would this problem have on vital signs if it isn’t treated?

Bradycardia

Hypertension

Hypothermia

Tachypnea

Test 1

For that problem, what would auscultation of the bowel sounds show?

Hypoactive

Hyperactive

Test 1

What type of lab order do you anticipate the provider ordering?

A stool specimen for culture and sensitivity

Fecal occult blood test

Test 1

What medications might you see ordered to help with this problem?

Docusate sodium (Colace)

Polyethylene Glycol (Miralax)

Bisacodyl (Dulcolax)

Loperamide (Imodium)

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Test 4

Test 5

Final Test

Test 1

The client is a 62-year-old presenting to the provider’s office for an annual check-up. The client has a history of hypertension, atrial fibrillation, and diabetes mellitus. Upon examination, the client tells you that they have not had a bowel movement in several days. What gastrointestinal problem do you anticipate based on that information?

Constipation

Diarrhea

Test 1

What signs or symptoms would you expect with the problem you suspect?

Hyperactive bowel sounds

Hunger

Multiple bowel movements

Malaise

Test 1

For that problem, what would auscultation of the bowel sounds show?

Hypoactive

Hyperactive

Test 1

What type of procedure do you anticipate being ordered?

Colonoscopy

Soap suds enema

Test 1

What medications might you see ordered to help with this problem?

Docusate sodium (Colace)

Antimicrobials

Bismuth subsalicylate (Pepto Bismol)

Steroids

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Test 4

Test 5

Final Test

Test 1

The client is a 62-year-old presenting to the provider’s office for an annual check-up. The client has a history of hypertension, atrial fibrillation, and diabetes mellitus. Upon examination, you note the client has absent bowel sounds and notify the provider. The provider has ordered a nasogastric tube to be placed. What indication is there for an NG tube?

Gastric Decompression

Tube feeding

Test 1

How do you check for confirmation of placement with an NG tube. Which method is the gold standard?

monitoring respiratory status

Auscultation over the abdomen while administering a small volume of air

aspirating gastric contents

Chest X-Ray

Test 1

What assessment findings would suggest that the NG tube is not working correctly in this scenario?

Hypoactive bowel sounds

Abdominal distention

Diarrhea

Test 1

These are 4 interventions related to nasal and oral care for an NG tube. One of them is incorrect. Which one is incorrect?

Full strength mouthwash

Ice chips

Oral swabs

Lubricant to the lips

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Test 4

Test 5

Final Test

The nurse is caring for a client that has the following: Intake: Normal saline infusing at 100 mL / hour. 3 ounces of drink provided with each meal, and there are 3 meals throughout the day. 6 ounces of water given with medications throughout the day. Output: 2250 mL output from a urinary catheter 120 mL from a JP drain 200 mL from an NG tube

The nurse is caring for a client that has the following: Intake: D5 0.45% normal saline infusing at 75 mL / hour. 6 ounces of drink provided with each meal, and there are 3 meals throughout the day. 5 ounces of water given with medications throughout the day. Output: 1500 mL voided urine output 100 mL from a JP drain 100 mL of emesis

Tests

Complete each test to beat the game: there is no other way to escape!

Test 1

Test 2

Test 3

Final Test

Test 5

Test 4

The nurse is caring for a client that has the following: Intake: Glucerna (tube feeding) infusing at 50 mL / hour. 30 mL free water flush given every 6 hours 180 mL water used when giving medications throughout the day Piperacillin antibiotic given every 8 hours. Comes mixed in a 50 mL bag per dose. Output: 1380 mL urinary catheter output

The nurse is caring for a client that has the following: Intake: 5% dextrose in water (D5W) infusing at 125 mL / hour. 5 ounces of drink provided with each meal, and there are 3 meals throughout the day. 10 ounces of water given with medications throughout the day. Output: 2850 mL urinary catheter output 60 mL from a chest tube 400 mL of colostomy output

Completed

Congratulations, you have successfully completed the escape room! Please raise your hand to let Professor Harrell see your completed escape room!

Start over?

Intake: Normal saline infusing at 100 mL / hour. 3 ounces of drink provided with each meal, and there are 3 meals throughout the day. 6 ounces of water given with medications throughout the day. 100 * 24 = 2400 3 * 30 = 90. 3 meals a day 90 * 3 = 270 6 * 30 = 180 2400 + 270 + 180 = 2850 Output: 2250 mL output from a urinary catheter 120 mL from a JP drain 200 mL from an NG tube 2250 + 120 + 200 = 2570 Calculate the fluid balance for the client over the 24-hour period described. (Fluid balance means Intake – Output). 2850 – 2570 = 280

Intake: D5 0.45% normal saline infusing at 75 mL / hour. 6 ounces of drink provided with each meal, and there are 3 meals throughout the day. 5 ounces of water given with medications throughout the day. 75 x 24 = 1800 6 * 30 = 180 * 3 = 540 5 * 30 = 150 1800 + 540 + 150 = 2490 Output: 1500 mL voided urine output 100 mL from a JP drain 100 mL of emesis 1500 + 100 + 100 = 1700 Calculate the fluid balance for the client over the 24-hour period described. (Fluid balance means Intake – Output). 2490 – 1700 = 790

Intake: Glucerna (tube feeding) infusing at 50 mL / hour. 30 mL free water flush given every 6 hours 180 mL water used when giving medications throughout the day Piperacillin antibiotic given every 8 hours. Comes mixed in a 50 mL bag per dose. 50 x 24 = 1200 30 * 4 (flush every 6 hours is 4 times a day so multiply by 4) = 120 180 for meds Antibiotic given 3 times a day. 50 * 3 = 150 1200 + 120 + 180 + 150 = 1650 Output: 1380 mL urinary catheter output Calculate the fluid balance for the client over the 24-hour period described. (Fluid balance means Intake – Output). 1650 – 1380 = 270

Intake: 5% dextrose in water (D5W) infusing at 125 mL / hour. 5 ounces of drink provided with each meal, and there are 3 meals throughout the day. 10 ounces of water given with medications throughout the day. 125 x 24 = 3000 5 x 30 = 150 x 3 = 450 10 * 30 = 300 3000 + 450 + 300 = 3750 Output: 2850 mL urinary catheter output 60 mL from a chest tube 400 mL of colostomy output 2850 + 40 + 400 = 3310 Calculate the fluid balance for the client over the 24-hour period described. (Fluid balance means Intake – Output). 3750 – 3310 = 440

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Creatinine = 4

Platelets = 3

Potassium = 2

Hemoglobin = 1