ACID-BASE ESCAPE ROOM

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NSG 310 Foundations of Nursing November 20, 2023

Acid-Base Escape Room

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It is 2026, and you've secured your dream job as a float pool RN. You graduated from your nurse residency recently, and you are up for a new challenge. You loved your time at WCU so much you almost want to go back to nursing school! You would love to precept a senior student in practicum. You decide to really shine in the hopes of being picked to precept a student.

Introduction

Complete each shift to beat the game: there is no other way to become a preceptor!

Shifts

Final Shift

Shift 5

Shift 4

Shift 3

Shift 2

Shift 1

Shift 1

Collect labs and administer oxygen

Collect labs and hang IV fluids

Collect labs and obtain an EKG

1/3

You are working in the ED today. A 77 year old woman from a nursing facility comes in with weakness and altered mental status. Her vital signs are: HR 114, BP 82/50, RR 24, SpO2 92%, T 102.6FWhat are your priority actions?

Labs should be collected on a patient with unstable vital signs. Especially with a fever, you would want to know a WBC count. With weakness and altered mental status, you need to be curious about electrolytes and general organ function. Labs are a must. IV fluids are a great choice for high HR, low BP, and weakness. We need to stabilize the cardiovascular system to keep perfusion to organs. An EKG may be part of a later workup, but with no symptoms of chest pain, it does not need to be an immediate action. Prioritize getting the BP stabilized and seeing what the labs reveal. Oxygen does not need to be immediately applied with an SpO2 of 92%.

Rationale

Shift 1

Replace the Foley catheter and pull off a sample from the tubing port

Use the sample port from the tubing port

Remove the catheter and perform an I/O

2/3

As you go in to hang the IV fluids, you realize your patient is harder to arouse. You let the provider know and they add an arterial blood gas (ABG) order along with the other lab work. Meanwhile you start the IV fluids and continue to assess the patient. You realize the patient has a Foley catheter that was folded up under her legs. There is a small amount of dark, cloudy urine. A urine culture is ordered. How do you collect your sample?

If a patient arrives to the hospital with a chronic indwelling catheter, there is a reason it was originally placed. If you cannot determine when it was last placed and you need a urine sample for a culture, you would need to recath the patient. Since outpatient providers have determined she needed an indwelling catheter, we will need to replace the catheter for now.

Rationale

Using a sample port from a catheter that was not recently placed or replaced will not provide the best sample. Sampling from old tubing may gather bacteria that have colonized the tubing or bag. To get a more accurate sample from the bladder/urinary tract, the catheter needs to be new before drawing a sample from the tubing port.

Rationale

Shift 1

Metabolic alkalosis

Metabolic acidosis

Respiratory alkalosis

Respiratory acidosis

3/3

Labs are back for your patient. ABG results:pH 7.14, PaCO2 28 mm Hg , HCO3- 14 mEq/L, PaO2 88 mm Hg What is the disorder?

pH 7.14, PaCO2 28 mm Hg , HCO3- 14 mEq/L

Complete each shift to beat the game: there is no other way to become a preceptor!

Shifts

Final Shift

Shift 5

Shift 4

Shift 3

Shift 2

Shift 1

Shift 2

You work the next day in the ICU and the patient you admitted yesterday with urosepsis is assigned to you. You get report that the patient became delirious and agitated overnight and lorazepam was administered. During bedside shift change you find your patient very difficult to arouse. The provider is notified and an ABG is ordered.

1/4

Shift 2

Next

2/4

You want to be able to explain the Allen's test to your future preceptee. You practice on your coworkers to make sure you have the technique down. Press the blue button after you watch the video.

Partially compensated respiratory alkalosis

Compensated respiratory acidosis

Shift 2

Uncompensated Respiratory acidosis

Compensated respiratory alkalosis

3/4

The blood gas has resulted. pH 7.32, PaCO2 63 mm Hg, HCO3- 25 mEq/L, PaO2 87 mm Hg What is the interpretation?

pH 7.32, PaCO2 63 mm Hg, HCO3- 25 mEq/L

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Shift 2

Complete each shift to beat the game: there is no other way to become a preceptor!

Shifts

Final Shift

Shift 5

Shift 4

Shift 3

Shift 2

Shift 1

Shift 3

Increase ventilation

Decrease respiratory rate

Improve hypoxia

1/3

You come back the next day for another shift and you have the same patient assignment in the ICU. The patient remained in respiratory acidosis and has been on Bipap overnight. What is the rationale for this?

Advanced Topic!

Test 3

Adjust respiratory rate to improve ventilation

Adjust FiO2 to improve oxygenation

2/3

Watch this video:What settings on the Bipap will improve future ABGs with a patient in respiratory acidosis?

No

Yes!

Did you de-escalate the daughter?

Role play with a peer to practice communication strategies to reassure the family member

The patient's daughter is in the room and says the following. "I cannot stand for my mom to be poked and prodded, look how bruised she is! Didn't you already draw blood this morning?"

Shift 3

Bipap settings have been adjusted to increase ventilation (increasing respiratory rate and volume to assist with more CO2 being exhaled). There is another order for an ABG to assess effectiveness of interventions.

3/3

How do you respond

Complete each shift to beat the game: there is no other way to become a preceptor!

Shifts

Final Shift

Shift 5

Shift 4

Shift 3

Shift 2

Shift 1

Shift 4

Alkalotic

Acidotic

It is another day in the Emergency Department. You are caring for a patient who had a witnessed seizure at home with no history of seizure disorder. This symptom is more likely to be a result of ____________ disorders.

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pH 7.38CO2 30 HCO3- 28

pH 7.48CO2 50 HCO3- 30

pH 7.28CO2 40 HCO3- 30

pH 7.51CO2 40 HCO3- 28

Shift 4

Well done!Choose an ABG that shows partially compensated metabolic alkalosis

2/3

Shift 4

Insomnia

Gastroesophageal reflux disorder

Type 2 diabetes

Hypertension

3/3

The patient wants to know why he had a seizure. What in his history makes you think why he developed a metabolic alkalosis that led to his seizure?

Complete each shift to beat the game: there is no other way to become a preceptor!

Shifts

Final Shift

Shift 5

Shift 4

Shift 3

Shift 2

Shift 1

Shift 5

pH 7.32, PaCO2 40, HCO3 20

pH 7.45, PaCO2 45, HCO3 22

pH 7.50, PaCO2 26, HCO3 26

1/3

A rapid response is called on the med-surg floor and as an ICU nurse, you respond. The client is post-op day 2 after hip surgery to repair a fracture. He is on a high-flow nasal cannula on 10L, SpO2 86%. He is diaphoretic, clutching his chest and deeply breathing 34 breaths/min. If you drew an ABG, what results would you expect?

A chest XRay to diagnose an asthma attack

An EKG to diagnose a heart attack

A head CT to diagnose a stroke

A chest CT to diagnose a pulmonary embolism

Shift 5

What diagnostic tests may you expect, knowing he is in respiratory alkalosis?

2/3

Shift 5

6. Extremity tingling

SOLUTION

5. Tachycardia

4. Edema

Solución

3. Diarrhea

2. Bradycardia

1. Dizziness

Not likely to experience

Experiencing

On a more thorough assessment, what additional symptoms may the patient be experiencing? (Respiratory alkalosis)

continuE

3/3

Complete each shift to beat the game: there is no other way to become a preceptor!

Shifts

Final Shift

Shift 5

Shift 4

Shift 3

Shift 2

Shift 1

+ info

Your unit-based educator conducts an annual competency written test to assess knowledge and critical thinking. This helps them guide future education and learning activities. You sit down to take the exam and hope that a good score will prove you are ready to teach a senior WCU student.

1. For acid-base disorders, to correct the pH imbalance, interventions are aimed to treat the _____________ cause.

Annual Competency

This page is password protected

treat the ___________ cause

Compensation

Acid-Base Disorder

metabolic alkalosis

metabolic acidosis

respiratory alkalosis

respiratory acidosis

Final Shift

D. Kidneys attempt to decrease HCO3-. Takes hours to days

C. Lungs hyperventilate to rid body of excess CO2. Fast process.

B. Kidneys attempt to increase HCO3-. Takes hours to days

A. Lungs hypoventilate to retain CO2. Fast process.

Solution

Solución

continue

3/3

Drag and sort correctly

Click on the computer & find a resource you can save

Start over?

Congratulations, you have successfully impressed your educator and manager!You are selected to be a preceptor and could not be more overjoyed at the thought of influencing the future of nursing! Click this link (hover & click the full screen/new tab option)to have another adventure!

Completed

Oh oh!

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

That answer is not correct...

back

genial.ly

Go to your shifts ready to work and see if you can impress your manager and unit educator with your critical thinking skills!

What medication may the patient be taking to treat this disorder... What may reduce too much acid?

Medications

What medication may the patient be taking to treat this disorder... What may reduce too much acid?

Medications

You must correctly fill in the blank, this is your password to advance to the next exam question.

Although renal failure can cause metabolic acidosis, the patient presenting here has infection symptoms Click on the correct answer to continue

Try again

What medication may the patient be taking to treat this disorder... What may reduce too much acid?

Medications

Perform the Allen's test. Compare hands. Trade doing the activity with a peer

Practice Time!

With your peer's permission:

This is a partially compensated disorder. All the values are abnormal. The pH would have to be within normal range to be considered compensated.

Try again

4 = A

3 = C

2 = D

1 = B

Compensated disorders have a NORMAL pH and abnormal PaCO2 and HCO3- Partially compensated have ALL abnormal pH, PaCO2 and HCO3- Uncompensated have abnormal pH and abnormal PaCO2 OR HCO3-

Compensation

3 = B

2 = A

1 = C

Hyperventilation would result in lower CO2 levels and a respiratory alkalosisClick on the correct answer to continue

Try again

2 3 4

Not likely experiencing

1 5 6

Experiencing