Horror Escape Room

The Horrors of acid base imbalance Escape room

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Citations

Before we start, we just want you guys to know we didn't pull this out of our butts in a state of metabolic acidosis. Here are our sources! Bosworth, C.(October 8, 2024). Unit 3: Acid- base balance. prezi.com. https://prezi.com/view/NkW4U eQSGb5IeFacxome/ Ignatavicius, D. D. (2024). Clinical companion for medical-surgical nursing (11th ed.). Elsevier Health Sciences (US). https://pageburstls.elsevier.com/books/9780443116605Links to an external site.

Introduction

"A ghost that was once a nursing student is trapped in this house, doomed to wander it until he regains all his memories about acid base imbalances! To help this ghost find them, you must first overcome all the challenges and collect the missing objects in your inventory. Explore the house and try not to gettrapped yourself…"

Concept and Exemplars

Concept: Acid Base Balance Exemplars: Respiratory Acidosis, Respiratory Alkalosis, Metabolic Acidosis, Metabolic Alkalosis Connection between Concept and Exemplars: Failure to maintain the proper ranges of pH, acids, and bases in the body leads to these respiratory and metabolic imbalances and possibly fatal organ involvement... spooky! Correction of the cause corrects the acid-base imbalance

Basic Patho of Respiratory Acid Base Imbalances

Respiratory Acidosis: pH < 7.35 with associated high levels of CO2 and normal (uncompensated) or high (compensated) levels of HCO3-. Occurs as a result of hypoventilation Respiratory Alkalosis: pH > 7.45 with associated low levels of CO2 and normal (uncompensated) or low (compensated) levels of HCO3-. Occurs as a result of hyperventilation

Basic Patho of Metabolic Acid Base Imbalances

Metabolic Acidosis: pH < 7.35 with associated high levels of H+ and/or low levels of HCO3-. Occurs as a result of acid overproduction, acid under elimination, base underproduction, or base over elimination Metabolic Alkalosis: pH > 7.45 with associated low levels of H+ and/or high levels of HCO3-. Occurs as a result of acid over elimination or base over ingestion

Appropriate Lab Values

pH: 7.35-7.45CO2: 45-35 HCO3: 22-26 O2: 80-100 Values on the LEFT are indicative of ACIDOSIS Values on the RIGHT are indicative of ALKALOSIS

01

A patient presents with severe diarrhea from a bad case of gastroenteritis. What acid-base imbalance is this patient most AT RISK for?

Respiratory acidosis

Metabolic acidosis

Metabolic alkolosis

CORRECT! Other causes of metabolic acidosis are:

• Shock
• DKA - the body can't utilize glucose (due to a lack of insulin), so it breaks down fats for energy instead, creating ketones (which are acidic)
• Aspirin overdose: forces the body into a lactic acidosis state due to interference with the electron transport chain
• Renal failure- under elimination of H+ and underproduction of HCO3-
• Liver failure and alcoholism

02

You are treating a patient in the ER who begins to have a panic attack. This is a risk factor for which of the following acid base imbalance?

Metabolic acidosis

Metabolic alkalosis

Respiratory alkalosis

CORRECT!

Along with anxiety, hyperventilation, hysteria, pain, and overventilation with a respirator are all risk factors for respiratory alkalosis

03

You watch your dad eat a spoon full of baking soda after a meal. He says it helps his heartburn, but you know that is a risk factor of which of the following?

Metabolic alkalosis

Respiratory alkalosis

Metabolic acidosis

CORRECT!

Other risk factors for metabolic alkalosis include diuretic use, antacids, vomiting, NG suctioning, and sodium bicarbonate administration during a blood transfusion

04

A patient with a history of asthma presents to the ER with shortness of breath. She is at risk for which of the following acid-base imbalances?

Respiratory alkalosis

Metabolic alkalosis

Respiratory acidosis

CORRECT!

Other risk factors of respiratory acidosis include COPD, pneumonia, pulmonary embolism, and CNS depressant use

This is not correct...

Find the key to continue

01

A pt presents with lethargy, low BP, low RR, and low O2. The patient is having trouble breathing. What are these cues of?

Respiratory alkalosis

Respiratory acidosis

Metabolic acidosis

Metabolic alkalosis

CORRECT! Now let's talk about complications

Complications for respiratory acidosis include CNS depression, hypoxia, and hyperkalemia (which can cause cardiac dysrhythmias)

02

A pt presents with diarrhea, Kussmaul respiratons, N/V, low HR/BP, and elevated T waves in the ECG. What are these cues indicative of?

Respiratory acidosis

Metabolic acidosis

Respiratory alkalosis

Metabolic alkalosis

CORRECT! Now let's talk about complications

Complications for metabolic acidosis include ECG changes, change in behavior, CNS depression, low blood sugar, and heart palpitations

03

Another pt presents with tachypnea (but O2 sats are 97%), change in behavior, and numbness/tingling. Their lab results show hypokalemia. Which acid-base imbalance are you witnessing?

Metabolic Alkalosis

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

CORRECT! Now let's talk about complications

Complications of respiratory alkalosis include seizures, skeletal muscle weakness and paralysis (including the diaphragm), and increased fall risk (from muscle weakness)

04

A pt presents with hypoventilation, tetany, twitching, high HR, and U waves in ECG. What are these cues indicative of?

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

CORRECT! Now let's talk about complications

Complications for metabolic alkalosis include seizure risk, fall risk, hypokalemia, and CNS excitation.

Use the magnifying glass to search for the priority intervention for metabolic alkalosis and then insert it into the typewriter

Seizure precautions

01

A patient is in metabolic alkalosis due to over-administration of sodium bicarbonate as a result of an emergency blood transfusion. Which nursing intervention would be performed?

Administer calcium gluconate

Place pt on seizure and fall precautions

Give an emetic to induce vomiting

CORRECT!

Nursing interventions for metabolic alkalosis include seizure and fall precautions. We would also monitor I/Os, turn down NG suctioning, establish an airway, and stop the trigger.

02

A patient is hyperventilating. What is our first nursing intervention?

Breathing exercises with the pt

Immediate sedation with a CNS depressant

Allow the pt time by themselves

CORRECT

Nursing interventions for respiratory alkalosis include breathing exercises and calming the patient down. Sedation is our last resort, other techniques must be tried first to decrease respiratory rate.

03

A patient is in respirtory acidosis. What is your priority nursing intervention?

Perform breathing exercises with the patient

Hydrate the patient

Reposition and administer O2

CORRECT

Though all these answers were correct, the PRIORITY nursing intervention for respiratory acidosis in to improve ventilation via repositioning and O2 administration.

01

You have a pt in metabolic acidosis with severe hyperkalemia. What is the most appropriate intervention?

Give sodium bicarb to replace the loss of base

Cardiac monitoring, insulin and dextrose

Give fluids and Kayexalate

CORRECT

Administering insulin helps correct the hypokalemia by allowing the potassium and glucose to enter the cells and leave the blood. Dextrose is given to replenish the blood sugar. Other interventions include giving kayexelate if the body can handle the hyperkalemia while it takes a few hours to exert its effect, monitoring neuro status, and starting dialysis if renal failure is the cause.

Congratulations

You have recovered all the memories of the ghost! Now it can finally rest and you can escape from the house!

Oh, no. You failed...

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