Genial Escape Room

start

Fluid & Electrolyte Edition

NUR 185 Escape Room

Current Symptoms: Fatigue Weakness Shortness of breath Confusion Diarrhea x 3 days

As Mr. Johnson's nursing team, your goal is to identify and manage his fluid and electrolyte imbalances, stabilize his vital signs, and escape the room

Your patient, Mr. Johnson, is a 65-year-old male admitted to the medical-surgical unit with a complex medical history. Your team will work together to assess, diagnose, and manage Mr. Johnson's fluid and electrolyte imbalances. Name: Mr. John Johnson Age: 65 Medical History: Hypertension Anxiety Chronic kidney disease (stage 3) Coronary artery disease

Introduction

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

Tests

Final Test

Test 5

Test 4

Test 3

Test 2

Test 1

Test 1

Fluid Volume Overload

Dehydration

Upon initial assessment you find his vitals are:Heart Rate: 110 bpm, Blood Pressure: 172/90 mmHg, RR: 22/min Oxygen Saturation: 92% on room air, Temperature 99.6, Pain level 3/10 Based on the vital signs and history, what could the patient be experiencing?

1/3

Test 1

Recent history of diarrhea

History of chronic kidney disease

History of hypertension

2/3

What was in the patient's history that could be contributing to fluid volume overload?

Test 1

Respiratory Rate 22

Blood Pressure 172/90

Temperature 99.6

Pain level 3/10

3/3

What vital sign led you to the priority problem of fluid volume overload?

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

Tests

Final test

Test 5

Test 4

Test 3

Test 2

Test 1

Test 2

Accessory Muscle Use

Jugular Vein Distention

Carotid Artery +2

Client Assessment:During your assessment, you notice the following findings that would indicate fluid overload. How would this be documented?

1/3

Test 2

+1 pitting edema

Severe non-pitting edema

+4 pitting edema

2/3

Further assessment reveals this finding. How would you document this?

Test 2

+1 pitting edema

Severe non-pitting edema

+4 pitting edema

2/3

Client Assessment:Further assessment reveals this finding. How would you document this?

Test 2

Crackles

Stridor

Diminished

3/3

Client Assessment: You are auscultating the client's lung sounds. How would you document these findings? Press "Play" on this video to hear the sounds.

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

Tests

Final Test

Test 5

Test 4

Test 3

Test 2

Test 1

Potassium 6.2 mEq/L Sodium 130 mEq/L Calcium 8.5 mg/dL Magnesium 1.9 mEq/L Creatinine 2.5 mg/dL

Test 3

Hyperkalemia

Hypernatremia

1/4

A BMP reveals the following results on your patient. The results indicate which condition

Potassium 6.2 mEq/LSodium 130 mEq/L Calcium 8.5 mg/dL Magnesium 1.9 mEq/L Creatinine 2.5 mg/dL

Test 3

False

True

2/4

The client's BMP indicates a sodium level that is within normal limits.

Test 3

3/4

When reviewing the BMP, which lab value would be your priority concern for this patient?

Test 6

The client's history of hypertension is a risk factor for hyponatremia.

The increased fluid is diluting the sodium level in the bloodstream.

The patient is not getting enough sodium in their diet and needs to start a supplement.

4/4

What do you think is the most likely cause for the patient's hyponatremia?

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

Tests

Final Test

Test 5

Test 4

Test 3

Test 2

Test 1

You, the nursing team, have identified that the client's priorities are fluid overload, hyperkalemia, and respiratory support needed due to hypervolemia. When addressing the hyperkalemia, what symptoms would you be most concerned for?

Test 4

Nausea

Confusion

Cardiac dysrhythmias

Positive Chvosteks sign

Tetany

1/3

Test 4

Oral Actonel 50mg

0.9% NS at 50mL/hr

Oral Spironolactone

IV Dextrose and 5 units IVP insulin

20 mEq Potassium Chloride IVPB

It is determined that the patient will need to be started on hemodialysis due to their CKD. However, the physician has also ordered continuous telemetry monitoring and medications to lower potassium level. What medication could be ordered to help lower the potassium level for this patient?

2/3

Test 1

(+) Chvostek & Trousseau sign

Thirst & dry mouth

Tetany & muscle spasm

Lethargy & confusion

3/3

The patient also currently has hyponatremia (Na 130 mEq/L). What other potential signs and symptoms may be seen in the patient due to this complication? * Consider why the patient is experiencing this abnormality

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

Tests

Final Test

Test 5

Test 4

Test 3

Test 2

Test 1

3 mLs

2 mLs

2.5 mLs

4 mLs

Test 5

1.5 mLs

1 mLs

The physician also orders furosemide IVP to help decrease fluid volume and potassium level. The order reads Lasix 40mg IVP x1 now. This is the vial/dose that you have on hand. How many mLs would you administer?

1/3

Test 5

Code: 2412

Code: 2024

Code: 1234

Raise your hand to receive supplies to draw up your lasix. When you draw up the correct dose, raise your hand again to receive the code to continue on.

2/3

Test 5

Encourage ambulation to encourage deep breathing and lung expansion

Place the client in Sims position to aid with lung expansion

Encourage fluid intake to thin mucous secretions

Applying supplemental oxygen via nasal cannula

The patient is also experiencing respiratory symptoms due to fluid overload (RR, SpO2 level, dyspnea, crackles upon ausculatation). What nursing interventions can be done to help the client while the underlying cause is being treated?

3/3

3/3

3/3

3/3

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

Tests

Final Test

Test 5

Test 4

Test 3

Test 2

Test 1

Test 6

Client is experiencing thirst and hunger

Client's weight has decreased and returned to baseline

Stools becoming less frequent and more solid

1/5

The client has been in the hospital for 36 hours and received one dialysis treatment. Which assessment would indicate that the client's priority problem (fluid overload) is resolving?

Pain has resolved

BP & HR within normal limits

Test 6

Continuing your evaluation of the client, which finding would not indicate that the client is showing improvement with fluid overload?

Clear lung sounds

2/5

Test 6

Drag and sort correctlyConsidering all the client's problems upon admission. Sort from highest to lowest priority. *Once you have selected your anser, click 'Solution' to compare answers.*

E. Hyperkalemia, risk for dysrhythmias

D. Fluid volume overload

C. History of anxiety

SOLUTION

B. Hyponatremia, risk for coma

A. Respiratory distress

continuE

3/5

Test 6

Client does not have any muscle cramping

Patient is alert and oriented now

Client does not need supplemental oxygen now

4/5

What finding would indicate that the client's hyponatremia is resolving?

Test 6

"You will need to drink about 2.5 Ls of water a day to flush out the kidneys."

"You will need to limit foods such as prunes, potatoes, and bananas."

"You will need to switch out table salt for a salt substitute."

5/5

The client needs education on a low potassium /renal diet. What would the nurse include with this teaching?

Start over?

Congratulations, you have successfully assessed, treated, and evaluated your patient!

Completed

Oh oh!

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

That answer is not correct...

back

5 - C

4 - B

3 - E

2- D

1 - A