Genial Escape Room

NUR 185 Escape Room

Fluid & Electrolyte Edition

start

Introduction

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

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

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

1/3

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?

Fluid Volume Overload

Dehydration

Test 1

2/3

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

History of hypertension

History of chronic kidney disease

Recent history of diarrhea

Test 1

3/3

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

Pain level 3/10

Temperature 99.6

Respiratory Rate 22

Blood Pressure 172/90

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

1/3

Test 2

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

Carotid Artery +2

Jugular Vein Distention

Accessory Muscle Use

2/3

Test 2

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

+4 pitting edema

Severe non-pitting edema

+1 pitting edema

2/3

Test 2

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

+4 pitting edema

Severe non-pitting edema

+1 pitting edema

3/3

Test 2

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.

Diminished

Stridor

Crackles

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 3

1/4

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

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

Hypernatremia

Hyperkalemia

Test 3

2/4

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

True

False

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

3/4

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

4/4

Test 6

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

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

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

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

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

1/3

Test 4

Tetany

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?

Positive Chvosteks sign

Cardiac dysrhythmias

Confusion

Nausea

2/3

Test 4

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?

20 mEq Potassium Chloride IVPB

IV Dextrose and 5 units IVP insulin

Oral Spironolactone

0.9% NS at 50mL/hr

Oral Actonel 50mg

Test 1

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

Lethargy & confusion

Tetany & muscle spasm

Thirst & dry mouth

(+) Chvostek & Trousseau sign

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 5

1/3

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 mLs

2.5 mLs

1.5 mLs

3 mLs

4 mLs

2 mLs

Test 5

2/3

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.

Code: 1234

Code: 2024

Code: 2412

Test 5

3/3

3/3

3/3

3/3

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?

Encourage fluid intake to thin mucous secretions

Place the client in Sims position to aid with lung expansion

Applying supplemental oxygen via nasal cannula

Encourage ambulation to encourage deep breathing and lung expansion

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

1/5

Test 6

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?

Stools becoming less frequent and more solid

Client's weight has decreased and returned to baseline

Client is experiencing thirst and hunger

2/5

Test 6

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

BP & HR within normal limits

Pain has resolved

Clear lung sounds

3/5

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.*

A. Respiratory distress

B. Hyponatremia, risk for coma

C. History of anxiety

D. Fluid volume overload

E. Hyperkalemia, risk for dysrhythmias

continuE

SOLUTION

Test 6

4/5

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

Client does not need supplemental oxygen now

Patient is alert and oriented now

Client does not have any muscle cramping

Test 6

5/5

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

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

"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."

Completed

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

Start over?

Oh oh!

That answer is not correct...

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

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1 - A

2- D

3 - E

4 - B

5 - C