WARD 516:The balance lockdown

WARD 516:The balance lockdown

Test your knowledge about electrolyte and pH imbalances as you work to escape your locked unit

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The mission

The unit is in chaos! The IV pumps are alarming, the ABG results just came in, and your patient’s electrolytes are all over the place. The charge nurse has locked the doors until the team stabilizes the situation — you can’t leave until balance is restored! Work together with your fellow nurses to analyze ABGs, correct fluid and electrolyte imbalances, and choose the right IV solutions. Each correct answer and puzzle solved brings you one step closer to “homeostasis” — and one step closer to escaping the unit before shift change!

Patient alarms

Look around the room to find more information, then click on the IV fluids to move on when you're ready

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Patient alarms

Look around the room to find more information, then click on the red power outlet to move on when you're ready

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Patient alarms

Look around the room to find more information, then click on the styrofoam cup to move on when you're ready

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Patient Alarms

Look around the room to find more information, then click on the nurse's stethoscope to move on when you're ready

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Patient alarms

Look around the room to find more information, then click on the window to move on when you're ready

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Shift complete

You stabilized every patient, prevented multiple crises, and made it through the shift. You can finally go home and relax — though you’ll probably still hear call bells and monitor alarms in your head for the next five hours..

Start over

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Vital Signs

Blood Transfusion

Celia is a 25 year old patient who was admitted for symptomatic anemia (Hgb 6.2 g/dL) related to chronic GI bleeding from ulcerative colitis. She is receiving 1 unit of PRBCs and has tolerated past transfusions well. You have:

• Performed all of your checks
• Started the blood at 120 mL/hr
• Arranged for your coworkers to keep an eye on your other patients while you remain with Celia for the first 15 minutes of the transfusion

Alex Taylor MRN: 256782

32 year old pt admitted following marathon with c/o dizziness, weakness, and poor oral intake. Mucous membranes dry, urine output 15 mL/hr. Notes he had been recovering from a GI bug the week prior to the race.

EKG Results

An EKG was performed after Harry complained of feeling chest tightness and the results showed:

• Sinus Bradycardia (HR 52)
• Tall, Peaked T-Waves

George Frank MRN: 457781

George was admitted with a small bowel obstruction and has been NPO with a nasogastric tube (NGT) to low continuous suction for 48 hours. Overnight, he began complaining of weakness, lightheadedness, and muscle cramping.

NG Tube

Inserted: 10/20 @ 0800

52 cm @ R nare set to low continuous suction 0800 - 400 mL of green gastric fluid noted in suction canister

Blood Gasses + Labs

• pH = 7.50
• PaCO2 = 44 mmHg
• HCO3 = 30 mEq/L

• K+ = 3.1 mEq/L
• Cl- = 94 mEq/L
• Na+ = 140 mEq/L

Harry Peterson MRN: 786453

Marcus 67 year old male patient with stage IV chronic kidney disease and hypertension (takes Lisinopril and furosemide at home). He was admitted for fatigue and mild shortness of breath. This morning, telemetry begins to alarm for rhythm changes, and lab results just posted.

Nursing Assessment

The patient reports increased thirst, dry mouth, and frequent urination. Denies nausea or blurred vision. No history of diabetes.

• Fingerstick blood glucose 208
• Rhoncorous lung sounds
• Warm, dry skin
• Pale yellow urine

Nursing Assessment

• Dry mucous membranes
• Decreased skin turgor
• Overall pale appearance
• Lethargy
• Muscle strength 4/5 in all extremities
• Clear lung sounds

Celia Brown MRN: 930419

Prior to starting the blood transfusion, Celia's vitals were as follows:

Ronald Graup MRN: 763376

Ronald is a 64 year old man admitted for pneumonia with respiratory distress. PMH of COPD. He is currently on IV methylprednisolone 40mg q6hr and Ceftriaxone 1g IV daily.

Nursing Assessment

• HR: 54, BP: 108/64, RR: 20, Temp: 98.4, SpO2: 98%

• Generalized weakness and fatigue
• Tingling in fingertips
• Nausea
• Chest tightness
• Shortness of breath