L520 Escape Room
Start
Intro
It's one of those days on L5 where everything that could go wrong, does go wrong. When your patient becomes very unstable, you find it very hard to leave the room. Will you ever be able to go on break? Who can get out of the room first? Each nurse must participate in all scenarios for credit.
Next
Patient A
Next
72 year old male, English speaking History of AF, CHF, and BPH P/w GLF with head trauma to the right side of the head, found to have a L frontal ischemic stroke and a R IPH. Neuro: AOx2-3, fluctuates, Left extremities are weak but able to move, Right side flaccid. Cardiac: on tele, AF in 80s, BP 135/92 Pulmonary: on RA, minimal wheezing and diminished lung sounds GI: Incontinent, Last BM yesterday, on a soft and bite sized diet, thin liquids GU: Foley placed 15 days ago for retention Skin: dry, fragile skin, bruising on R elbow and hip, coccyx is red but blanchable Vascular: PICC x2 lumen on left upper arm, last dressing change done 4 days ago
Patient B & C
Next
Your other two patients are very similar. Both Patient B & C are phase 1 patients who are off all of their AEDs and waiting for an event. They both have staring spells and was just admitted 2 days ago. They are both AOx4 and BMAT 4. Because these 2 patients were sleeping by the time you were done with report, you go to check on Patient A to get started on assessments and his 0700 meds.
L520-L520A
L526-L526A
L536-L536A
Morning Assessments
You start by doing your full head-to-toe assessment, including your stroke assessment for this patient. Complete the stroke quiz given to you. You may work together with your team but EACH PERSON MUST FILL OUT THEIR OWN QUIZ to get credit. Once complete, add up the numbers of the correct answers on the quiz according to the key to the right. Add 0 for the question that is open answer (#7). Ex: If questions 1 and 2 are both A, that would be 1+1=2...etc This number will unlock the locker in the next slide.
A=1 B=2 C=3 D=4
Next
Pick the correct locker according to your answers
Back
Incorrect :(
Please check your answers on your quiz for the correct answer.
Back
Correct!
Great job!
Next
L520-L520A
L526-L526A
L536-L536A
Suddenly, Patient A starts seizing!
Patient A starts having eyes rolling up and to the right, unresponsive to voice, and shaking his left extremities. He does not have any prior history of seizures. Run up to the front to grab the Epilepsy placards. Rearrange what steps you should take to ensure your patient's safety! Your next clue will be within those steps. Use the clue to unlock your Voalte phone (Next slide).
Next
Back
Sorry, Please try again
Click anywhere to try your passcode again from the start.
Team Notified and aware
Your patient has stopped seizing now after 2 minutes of shaking. MD and Critical Response RN have been notified. Patient A is now on EEG after finishing his CT Head, which did not show any increase in size of his stroke. Your patient says he is thirsty and wants some water now. You had initially charted a failed swallow screen 2 hours ago due to his somnolence and seizure. However, he is much more awake now, back to baseline at AOx3, and following commands. Reminder: Patient A was evaluated by SLP 2 days ago and recommended a soft and bite sized diet with thin liquids.
Next
Would you perform a swallow screen on your patient?
No
Yes
Come to the front to pick up a cup of water!
Next
Come to the front and tell natalie password "pink sponge"
Next
Administer swallow screen to your teammate
You'll find the passcode to the nutrition room upon administering the swallow screen!
Next
Click on the correct passcode to unlock the nutrition room
8146
6427
8345
9754
1171
3124
1311
8451
4431
9463
7641
1243
1241
1231
0121
4871
Not quite, try again
Back
You did it! you get into the nutrition room to get your patient more water.
Next
L520-L520A
L526-L526A
L536-L536A
foley care
You finally finish up your patient's 0900 and 1000 meds with the rest of your assessment. You are getting hungry and want to go on breakfast. But you realize you haven’t charted your I/Os yet all morning. You decide, better do it now while you're still in the room.
Next
Foley Order
Today is 1/31/24. Patient A has this order above.
Next
Foley care
Next
Foley care
Patient A has a history of UTI from a week ago and so has been on antibiotics. As you are charting his I/Os, you notice that he is diaphoretic. His temperature is elevated from last time you checked it at 100.5F. You also notice his heart rate has been climbing during the last couple of hours, now in 120-130s ST. You notify the MD of this change and a UA was ordered.
Next
Side quest:
Next
side quest
A patient was placed on a voiding trial after having had a Foley for 3 days. The Foley was removed on 2/1 at 6am. It is now 2/2 at 8pm. The patient has been straigth cath'ed twice now and may need a Foley reinsertion.
Next
Foley charting
Next
Foley charting
Whew! You finally finished up your Foley care with CHG wipes and done charting!
Next
L520-L520A
L526-L526A
L536-L536A
CLABSI prevention
Your break time is almost here! But you look at your patient's PICC line and see this. Go towards your station by the whiteboard for next steps.
Next
081
018
Enter the passcode to continue
180
108
801
810
Back
Not Quite, try again
Back
PICC line and iv tubing looks great!
Great job on your PICC line dressing change!
Next
L520-L520A
L526-L526A
L536-L536A
Finally a breakfast break!
Your float nurse is now here to break you! Great job! You finally made it out of your patient's room to go on break. Enjoy your breakfast!
Competency Day 2024
Natalie Hsueh
Created on January 31, 2024
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Transcript
L520 Escape Room
Start
Intro
It's one of those days on L5 where everything that could go wrong, does go wrong. When your patient becomes very unstable, you find it very hard to leave the room. Will you ever be able to go on break? Who can get out of the room first? Each nurse must participate in all scenarios for credit.
Next
Patient A
Next
72 year old male, English speaking History of AF, CHF, and BPH P/w GLF with head trauma to the right side of the head, found to have a L frontal ischemic stroke and a R IPH. Neuro: AOx2-3, fluctuates, Left extremities are weak but able to move, Right side flaccid. Cardiac: on tele, AF in 80s, BP 135/92 Pulmonary: on RA, minimal wheezing and diminished lung sounds GI: Incontinent, Last BM yesterday, on a soft and bite sized diet, thin liquids GU: Foley placed 15 days ago for retention Skin: dry, fragile skin, bruising on R elbow and hip, coccyx is red but blanchable Vascular: PICC x2 lumen on left upper arm, last dressing change done 4 days ago
Patient B & C
Next
Your other two patients are very similar. Both Patient B & C are phase 1 patients who are off all of their AEDs and waiting for an event. They both have staring spells and was just admitted 2 days ago. They are both AOx4 and BMAT 4. Because these 2 patients were sleeping by the time you were done with report, you go to check on Patient A to get started on assessments and his 0700 meds.
L520-L520A
L526-L526A
L536-L536A
Morning Assessments
You start by doing your full head-to-toe assessment, including your stroke assessment for this patient. Complete the stroke quiz given to you. You may work together with your team but EACH PERSON MUST FILL OUT THEIR OWN QUIZ to get credit. Once complete, add up the numbers of the correct answers on the quiz according to the key to the right. Add 0 for the question that is open answer (#7). Ex: If questions 1 and 2 are both A, that would be 1+1=2...etc This number will unlock the locker in the next slide.
A=1 B=2 C=3 D=4
Next
Pick the correct locker according to your answers
Back
Incorrect :(
Please check your answers on your quiz for the correct answer.
Back
Correct!
Great job!
Next
L520-L520A
L526-L526A
L536-L536A
Suddenly, Patient A starts seizing!
Patient A starts having eyes rolling up and to the right, unresponsive to voice, and shaking his left extremities. He does not have any prior history of seizures. Run up to the front to grab the Epilepsy placards. Rearrange what steps you should take to ensure your patient's safety! Your next clue will be within those steps. Use the clue to unlock your Voalte phone (Next slide).
Next
Back
Sorry, Please try again
Click anywhere to try your passcode again from the start.
Team Notified and aware
Your patient has stopped seizing now after 2 minutes of shaking. MD and Critical Response RN have been notified. Patient A is now on EEG after finishing his CT Head, which did not show any increase in size of his stroke. Your patient says he is thirsty and wants some water now. You had initially charted a failed swallow screen 2 hours ago due to his somnolence and seizure. However, he is much more awake now, back to baseline at AOx3, and following commands. Reminder: Patient A was evaluated by SLP 2 days ago and recommended a soft and bite sized diet with thin liquids.
Next
Would you perform a swallow screen on your patient?
No
Yes
Come to the front to pick up a cup of water!
Next
Come to the front and tell natalie password "pink sponge"
Next
Administer swallow screen to your teammate
You'll find the passcode to the nutrition room upon administering the swallow screen!
Next
Click on the correct passcode to unlock the nutrition room
8146
6427
8345
9754
1171
3124
1311
8451
4431
9463
7641
1243
1241
1231
0121
4871
Not quite, try again
Back
You did it! you get into the nutrition room to get your patient more water.
Next
L520-L520A
L526-L526A
L536-L536A
foley care
You finally finish up your patient's 0900 and 1000 meds with the rest of your assessment. You are getting hungry and want to go on breakfast. But you realize you haven’t charted your I/Os yet all morning. You decide, better do it now while you're still in the room.
Next
Foley Order
Today is 1/31/24. Patient A has this order above.
Next
Foley care
Next
Foley care
Patient A has a history of UTI from a week ago and so has been on antibiotics. As you are charting his I/Os, you notice that he is diaphoretic. His temperature is elevated from last time you checked it at 100.5F. You also notice his heart rate has been climbing during the last couple of hours, now in 120-130s ST. You notify the MD of this change and a UA was ordered.
Next
Side quest:
Next
side quest
A patient was placed on a voiding trial after having had a Foley for 3 days. The Foley was removed on 2/1 at 6am. It is now 2/2 at 8pm. The patient has been straigth cath'ed twice now and may need a Foley reinsertion.
Next
Foley charting
Next
Foley charting
Whew! You finally finished up your Foley care with CHG wipes and done charting!
Next
L520-L520A
L526-L526A
L536-L536A
CLABSI prevention
Your break time is almost here! But you look at your patient's PICC line and see this. Go towards your station by the whiteboard for next steps.
Next
081
018
Enter the passcode to continue
180
108
801
810
Back
Not Quite, try again
Back
PICC line and iv tubing looks great!
Great job on your PICC line dressing change!
Next
L520-L520A
L526-L526A
L536-L536A
Finally a breakfast break!
Your float nurse is now here to break you! Great job! You finally made it out of your patient's room to go on break. Enjoy your breakfast!