Sepsis Escape Room

Race Against Time

Escape Room

Turn up your volume for full effect

Start

Escape

Tasks

Introduction

Welcome! My name is Julia, and I'll be the nurse guiding you through your shift today. It's 7 a.m., and you'll be taking care of Jerry. He just arrived from the ED to our med-surg unit.

Let's meet Jerry

Escape

Tasks

Introduction

Let's get to know Jerry.

Hello!

Click on the button below to review his medical records.

Medical Records

Jerry Sanders

Nurses' Note

03/15/XX, 73-year-old, Male

1000: Client was brought to the ED by the patient's wife due to increased confusion this morning. Wife reports that the client has been running a fever and has increased urinary frequency for the past few days. Client c/o of dribbling with urination and body soreness. History of hypertension, atrial fibrillation, and benign prostate hyperplasia. Vital signs: Temperature 100.4F oral, HR 85 bpm, RR 18 breaths/min, BP 100/67 mmHg, pulse oximetry reading 87% on room air, now 93% on 2L NC. On assessment, the client's breathing appears slightly labored and coarse crackles noted in bilateral lung bases. Skin slightly cool to touch and pale pink in tone; pulses 2+ and regular. S1 and S2 audible. Capillary refill is 2 seconds. Client is alert and oriented to person and place but not time. PIV placed in right forearm, 20 gauge. Dressing is dry/intact and IV is saline locked.

Escape

Tasks

Introduction

Let's complete a focused assessment on Jerry.

Hover over the black circles to reveal your assessment findings.

Next

Jerry Sanders

Assessments

03/15/XX, 73-year-old, Male

For each patient finding below, click to specify if the finding is consistent with the disease process of pneumonia and/or urinary tract infection (UTI). Each finding may support more than 1 disease process.

Assessment Findings

UTI

Pneumonia

Fever of 100.7°F

Dull ache in right lower quadrant of the back

Alert and oriented x2

Patient reports feeling the need to go urgently but little to no output.

Productive cough with thick, purulent sputum.

Next

Looks like some of those tests you ordered came back.

Urine culture

Chest x-ray

Next

Jerry Sanders

Nursing Interventions

03/15/XX, 73-year-old, Male

For each potential nursing intervention below, click to specify whether the intervention is indicated or not indicated for the care of the patient.

Not indicated

Potential Nursing Interventions

Indicated

Place the patient in semi-Fowler's position

Restrict fluid intake to reduce the risk of fluid overload

Request an order to insert an additional peripheral IV

Apply cold compresses to the abdomen to relieve distention

Request an order for antibiotics

Next

It looks like Jerry's call light is on.

Click on the call light to see how you can help him.

"Where am I?"

"You're in the hospital Jerry. "

Next

A patient with a UTI is becoming increasingly confused. What is the priority nursing action?

Administer prescribed antipyretics to reduce fever.

Monitor the patient’s fluid intake and output for 24 hours.

Notify the healthcare provider immediately.

Reassess the patient’s vital signs and perform a neuro exam stat.

Correct!

Checking vital signs and performing a neuro exam quickly helps determine if the patient's condition is worsening, which can guide immediate actions.

Next

Try again

Reducing fever helps, but it’s not a priority for sudden confusion.

Back

Try again

Monitoring fluid balance is important for overall patient care, it is not an immediate action when confusion occurs.

Back

Try again

You should notify the provider, but first gather current vitals and assess the patient's condition.

Back

You've completed a neurological assessment and obtained new vitals

Click on the vitals machine and computer to reveal the vitals and assessment

Next

Hover over the buttons to reveal the assessment

Hover over the buttons to for a hint on GCS scale

Identify and click on the findings that indicate a decline in Jerry's condition.

1. Only oriented to person.

2. PERRLA with white sclera.

3. Radial pulses +2

4. Restless and occasionally agitated.

5. 89% on 2L NC

Code: The numbers corresponding to the correct answers form a code. Arrange the numbers in chronological order to unlock the next clue.

Arrange the correct answer numbers in chronological order.

Enter the password

I think you should call the provider and update them on Jerry's condition.

Click on the phone to call the provider

Hello, this is Dr. Johnson.

Provide SBAR

Click on highlighted sentences to add or fix this SBAR report

Hello Dr. Johnson, this is the nurse from the med-surg unit. I’m calling about Jerry Sanders, a 73-year-old male, who is pale, diaphoretic, weak, and alert and oriented to person only (A&O x1). He was admitted on 11/20 after presenting with confusion and fever.

His wife reports increased urinary frequency and body soreness for the past few days.

He has a history of atrial fibrillation, hypertension, and benign prostate hyperplasia. His recent UA showed bacteria and WBC indicating a UTI, and his chest x-ray indicated pneumonia. He is currently tachycardic with a The combination of altered mental status, fever, and unstable vital signs strongly suggests sepsis, likely related to his pneumonia and/or UTI.

HR 107, BP is 89/52, with SpO2 87% on 2L NC, and a fever of 101.6°F

I recommend ...

Jerry Sanders

Active Orders

03/15/XX, 73-year-old, Male

Review the orders prescribed by Dr. Johnson

Hang normal saline 1000mL infusing by gravity

Insert an indwelling urinary catheter

Give vancomycin (Vancocin) 1g IV

Obtain blood cultures

Titrate norepinephrine to keep MAP above 65 mmHg

Increase oxygen flow rate to 6L NC

Next

Escape

Tasks

Introduction

It looks like the ABG results are back... but I'm not sure what it means. Can you give me your thoughts?

Review ABGs

Jerry Sanders

Arterial Blood Gases

03/15/XX, 73-year-old, Male

Click on the appropriate box for current ABG

Lab

11/20/2024

Low

WNL

High

68

PaO2

mmHg

pH

7.31

PaCO2

38

mmHg

HCO3

19

mmol/L

Lactate

2.5

mmol/L

Next

A patient is admitted with a diagnosis of sepsis due to a urinary tract infection (UTI). Which of the following findings would indicate that the patient has transitioned to septic shock?

The patient shows signs of organ dysfunction but remains normotensive and is responsive to fluids.

The patient requires vasopressors to maintain a mean arterial pressure (MAP) of 65 mmHg despite receiving adequate fluid resuscitation.

The patient develops a fever, increased heart rate, and low urine output.

The patient’s blood pressure stabilizes after receiving IV fluids, and organ dysfunction is improving.

Escape

Tasks

Introduction

Correct!

Septic shock is diagnosed when sepsis progresses to include persistent hypotension (requiring vasopressors to maintain MAP ≥65 mmHg) despite fluid resuscitation and signs of tissue hypoperfusion defined by elevated lactate levels (Font et al., 2020).

Next

Escape

Tasks

Introduction

Try again

This option describes MODS (Multiple Organ Dysfunction Syndrome) with a MAP >65 mmHg, which does not meet the criteria for septic shock.

Back

Escape

Tasks

Introduction

Try again

This option describes sepsis but lacks the persistent hypotension and elevated lactate seen in septic shock.

Back

Escape

Tasks

Introduction

Try again

This option indicates improvement and stabilization, which would suggest that sepsis is under control, not progressing to septic shock.

Back

(Daniela Blumlein, 2022)

Escape

Tasks

Introduction

Stages of Septic Shock

Compensatory: The body increases heart rate, respiratory rate, and vasoconstriction to maintain blood flow to vital organs. Hormones like epinephrine and vasopressin help maintain blood pressure and volume, with the patient possibly showing cool, clammy skin.

Progressive: Blood pressure and cardiac output drop, causing tissue hypoxia and metabolic acidosis. Inflammatory mediators worsen perfusion, leading to organ dysfunction. Without intervention, this stage can result in kidney failure, cardiac issues, lung damage, and decreased consciousness.

Refractory: Also known as irreversible shock, marks the point where cellular damage is extensive and multiple organ failure occurs. At this stage, the patient is unresponsive to treatment, and death is imminent due to the irreversible nature of the damage.

Initial: The body tries to maintain homeostasis through subtle autonomic responses that regulate blood pressure, heart rate, and respiration. As cardiac output decreases, cells shift from aerobic to anaerobic metabolism, causing mild symptoms like feeling unwell, pale, and anxious.

Next

(Daniela Blumlein, 2022)

Escape

Tasks

Introduction

Jerry's wife is here, concerned about him. Since you've been working with him, could you go update her on his condition?

Talk to the family

Escape

Tasks

Introduction

Hi, I’m Jerry’s wife. I'm really worried about him. Can you tell us what’s going on? Last time I saw him he was confused, and now I can barely talk to him!

Explain status of patient

Right now, Jerry's experiencing septic shock, which is causing system-wide ____________.

vasoconstriction

vasodilation

hypoperfusion

vasodilation

This causes low blood pressure and impaired blood flow.

Next

Escape

Tasks

Introduction

We've followed the medication protocol you've provided, but I can't tell if Jerry is improving. Can you help me?

Reassess Jerry

For each assessment finding, drag to the corresponding concept slot

Skin is warm/dry

A&O x4

Output 20mL/hr

WBC 27,000

HR 85

BP 90/40

O2 92% RA

Cap refill <4 secs

Improving

Declining

HR 85

Output 20mL/hr

A&O x4

Cap refill <4 secs

Skin is warm/dry

O2 92% RA

BP 90/40

WBC 27,000

Next

Solution

Congratulations!

You've completed the escape room. Jerry might need some more recovery time, but he is on the path to recovery.

References

References

Daniela Blumlein, I. G. (2022, May 12). Shock: Aetiology, pathophysiology and management. British Journal of Nursing. https://www.britishjournalofnursing.com/content/clinical-pathophysiology/shock-aetiology-pathophysiology-and-management#:~:text=Stages%20of%20shock,2021;%20Tait%2C%202022). Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and septic shock – basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics of North America, 104(4), 573–585. https://doi.org/10.1016/j.mcna.2020.02.011 Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J.-D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J.-L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 315(8), 801. https://doi.org/10.1001/jama.2016.0287

Vitals

HR: 107 bpmBP: 89/52 mmHg SpO2: 87% on 2L NC Temperature: 101.6°F oral Respirations: 23 breaths/min

Lab Results

Physical Characteristics: Color: Dark yellow Clarity: Cloudy Chemical Analysis: pH: 6.5 Specific Gravity: 1.025 Protein: Trace (+) Glucose: Negative Ketones: Negative Nitrites: Positive Bilirubin: Negative Microscopic Examination: Bacteria: Moderate presence Casts: None detected Crystals: None detected

CXR Results

Impressions: Right lower lobe consolidation with air bronchograms, consistent with bacterial pneumonia. No evidence of significant pleural effusion. Recommend clinical correlation.

Neurological Assessement

No longer fully alert and is only oriented to person. Opens his eyes when spoken to but not spontaneously. Speaking but shows disorientation and confusion, making conversation that isn’t fully coherent. Can move his hand to a painful stimulus. Pupils are equal and reactive to light. He exhibits generalized weakness in his grip strength, though there are no abnormal movements or tremors noted at this time. Restless and occasionally agitated, shifting in bed and mumbling to himself. Moments of lethargy are also present when he becomes less responsive.