A7C Adventure Breakout

A7C BREAKOUT

AdVENTURe

START

Introduction

MISSION

CHARACTERS

CHOOSE YOUR DESTINATION

Destination 05

Destination 04

Destination 03

Destination 02

Destination 01

WELCOME to Destination 01

Welcome to the icy north.Here, cold is not the only challenge. Take a deep breath in... oh no is that a wheeze I hear!?

START

Start stop watch on phone.

QUESTION 01

Which Asthmatic patient can receive an IV Magnesium bolus on A7C?

The 3 y.o. with AMS and has been on continuous albuterol for 15 hours

The 18 m.o. with worsening respiratory distress that has been on continuous albuterol for 24 hours

The 2 y.o. that has been on continuous albuterol for 12 hours

QUESTION 02

What is the standard dosing for IV magnesium for asthma?

50mg/kg (max 2g) infused over 20 minutes

20mg/kg (max 2g) infused over 60 minutes

55 mg/kg (max 2g) infused over 20 minutes

QUESTION 03

True or False, A MRT is required to administer IV Maganesium on A7C?

True

False

QUESTION 04

True or False, A MRT is required to administer the initial dose of IV Maganesium on A7C?

True

False

QUESTION 05

True or False, Patients recieving IV Magnesium for asthma treatment should be evaluated by the provider prior to administration?

True

False

QUESTION 06

Which fluids run concurrently with IV Magnesium?

0.9 NS bolus of 60ml/kg (max 1L) given over 20 minutes

0.9 NS bolus of 20ml/kg (max 1L) given over 60 minutes

0.45 NS bolus of 20ml/kg (max 1L) given over 60 minutes

QUESTION 07

What is the most common side effect of IV Mag?

Nausea and Vomiting

Hypotension

Headache

If wrong, +10 secs to end time

QUESTION 08

QUESTION 09

Our 6-year-old patient has a blood pressure of 80/44 at 20 minutes into the IV magnesium infusion. What should we do next?

Notify the Team to come Bedside STAT

Nothing that is a normal BP

Stop the infusion and NS bolus.

CONGRATULATIONS

The first number is:

Back to map

WELCOME TO Destination 02

Samba, jungle, and mysteries! Brazilawaits you with tropical challenges ... and so does Cytoxan!

START

PREGUNTA 01

Cytoxan is idetenified as what level of hazardous medication?

High (Red)

Moderate (Orange)

Low(Green)

PREGUNTA 02

Next

Wrong: +10 secs to end time

ChemoPlus mats are placed underneath the patient's line while connectingand disconnecting the infusion from the patient. The 2nd Verifying RN can single glove during calculation and verification, they must double glove during administration. Gowns , gloves, masks, and eye protection must be worn for up to 48 hours post infusion wihile handling the patient's excretions.

Rationale

PREGUNTA 03

What type of IV access is required for a cytoxan infusion?

PIV

PICC

Midline

Next

Specific Gravity

QUESTION 04

Which lab result is typically used to determine when the cytoxan infusion can start?

CBC with Diff

Renal

QUESTION 05

The patient has an IV, their spec grav is 1.008,all other labs are WNL, what is the next step prior to administration?

Calculate the patient's BMI

Administer the ordered tylenol pre-med

Administer the ordered anti-emetic pre-med

Hint will cost you +20 secs

Next

As you are administering the patient's pre-medications, what other intervention should you also be doing about 15 mins before you start the infusion?

Next

Wrong answers: + 10 sec. to total time

Next

B𝑆𝐴(𝑚2 ) = √(ℎ𝑒𝑖𝑔ℎ𝑡 × 𝑤𝑒𝑖𝑔ℎ𝑡) ÷3600

Our patient is ready for their Cytoxan infusion. Before we start the medication we need to calculate our patients Body Surface Area (BSA). Our patient weighs 76 kg and they are 159.2 cm tall.

What is their BSA?

Next

Correct answer: 1.83

Next

Correct answer: 915 mg - 1,830 mg

PREGUNTA 07

The ordered cytoxan dose must be within a ___ % variance of the calculated safe dose range.

15%

10%

5%

PREGUNTA 08

Where do we document the cytoxan verification in EPIC?

In the Chemotherapy Nurse Verification Flowsheet

In the Cytoxan Infusion Verification Flowsheet

In the MAR comments

Next

The 2nd verifying RN calculated the same safe dose range. Quickly select one team member to dress up in the appropriate PPE for administering Cytoxan at station 1. Reward: dressed in < 30 sec= 1 min off total time dressed in < 1 min = 20 sec off total time dressed in < 1.5 mins = 10 sec off total time

00:00

Next

What else should you do?

PREGUNTA 09

Oh Nooo! You spiked the bag incorrectly and Cytoxan is all over the floor. What do you do now?

Call 803-Safe

Put a yellow absorbent mat over it and call EVS

Obtain a Chemo spill kit and follow the directions

PREGUNTA 10

Phew, the pharmacy delivered a new bag and the Cytoxin is finally infused. Now what do we need to do?

Flush 30 mLs of NS in the port directly under the infusion pump

Nothing

Flush 20 mLs of NS through the port closest to to the patient

PREGUNTA 11

The infusion bag is empty and the flush is complete, how do we dispose of the hazardous medication bag and tubing?

Throw it in the trash

Place in a HM safe bag and put it in the red bin for pharmacy pick up

Place in a bio hazard bag and put it in the biohazard bin

PREGUNTA 12

After cytoxan infusions, we monitor for what common side effect?

Hemorrhagic Cystitis

Acute kidney injury

Nephrotoxicity

PREGUNTA 13

After cytoxan infusions, how frequently should we be encouraging the patient to urinate?

Q 8H

Q 1H

Q 2H

Caffine Limitiation

Next

Bedrest

PO hydration encouragement

PREGUNTA 13

What interventions do we implement to monitor and prevent hemorrhagic cystitis? Select all that apply.

Qvoid Urine Assessment

Q4H/Qvoid Urine Specific Gravity checks

Qvoid UAs

How long do we need to wear the appropriate protective PPE while handling the patient's excretions post cytoxan?

PREGUNTA 14

24 hours

16 hours

48 hours

PREGUNTA 15

What medication is administered to prevent hemorrhagic cystitis post cytoxan?

Mesna

Ditropan

IVIG

PREGUNTA 16

How long does Mesna take to infuse?

8 hours

16 hours

24 hours

CONGRATULATIONS

The second number is:

Back to map

WELCOME TO Destination 03

Ah, the land of love and revolution.But here, love could be a trap, just like an obstructive airway.

START

QUESTION 01

When a ventilator is in a PC (Pressure contol) mode what does this mean?

A set pressure is provided during expiration

A set tidal volume is provided during inspiration

A set pressure is provided during inspiration

QUESTION 02

When a ventilator is in VC (Volume contol) mode what does this mean?

A set tidal volume is provided during expiration

A set tidal volume is provided during inspiration

A set pressure is provided during inspiration

The Ventilator

QUESTION 03

When a ventilator is in AC (assist contol) mode what does this mean?A set pressure/volume is provided each breath intiated by . . .

The Patient

Either the pt. or the vent

Pressure Control(PC)

QUESTION 04

Which mode allows the ventilator to provide a set number of breaths (RR) with a set pressure or volume while allowing spontaneous breaths?

Synchronized intermittent Mandatory Ventilation(SIMV)

Assist Control(AC)

QUESTION 05

A _____ provides continous postive airway pressure during inspitation and expiration for patient intiated breaths.

BiPAP

CPAP

QUESTION 06

A _____ provides a set IPAP/EPAP (inspiratory/expiratory positive airway pressure) and will trigger breaths if the patient does not spontaneously meet the required RR.

BiPAP

CPAP

QUESTION 07

Which setting can provide a higher pressure?

BiPAP

CPAP

to put the pt. back on the vent after suctioning

QUESTION 08

Which is NOT the responsibility of the Nurse while caring for a patient on a BiPAP or vent?

to give pt. a 100% breath

To ensure the exhaliation valve is clear of obstruction

to adjust the vent settings to what is ordered

QUESTION 09

A high pressure alarm is beeping on vent, what does this mean?

There is an airway resistance or plug

You need to call the RT to fix the vent

The ordered FiO2 setting is too high for the pt. and needs to be lowered

A low circuit leak/obstruction is beeping on the vent, what does this mean?

QUESTION 10

There is not an adequate exhalation leak.

The vent is unable to provide adequate pressure.

Their is a plug in the trach

QUESTION 11

The vent is now alarming Low Vte, what does this mean?

The pt. cannot exhale enough volume

The pt. cannot inhale enough volume

You really need to find that RT

QUESTION 12

UGH! Now the vent is alarming LMV (Low Minute Ventilation), what does low minute ventilation mean?

Pt. has a decreased exhaled tidal volumne

Pt. has a decreased RR

The pt. is not meeting their ventiliation settings

Step 5) Call code Blue and manually bag the patient

Step 2) Assess the airway

Step 4) Assess the vent and circut

Step 3) Call for help and change the trach

QUESTION 13

The vent is alarming low Vte, the patient is alert and oriented, SpO2 is 74%. As a team demonstrate and verbalize the next steps you would take if you saw this alarm at station 2

Step 1) Assess the Patient

CONGRATULATIONS

The third number is:

Back to map

WELCOME TO Destination 04

Deserts and pyramids, oh yes! Butwatch out for Hypoglycemia, I mean quicksand.

START

Next

IV

QUESTION 01

Before the start of the hypoglycemic challenge, the patient will need an ___ placed.

QUESTION 02

True or False, Hypoglycemic challenge patients need to be NPO?

True

False

QUESTION 03

Our hypoglycemic challenge patient just started their challenge. How frequently should we be getting finger stick POC BGs?

Q 3 H

Q 1 H

Q 30 mins.

QUESTION 04

Our hypoglycemic challenge patient just had a finger stick POC BG of 68. How frequently should we be getting finger stick POC BGs?

Q 3 H

Q 1 H

Q 30 mins.

QUESTION 05

Our pt. is diapered, we have have brought cotton balls into their room. When do we need to collect and send their urine to lab for a UA?

Qvoid until thier first void post hypoglycemia

Qvoid once their BG is confirmed under 70

Qvoid once BG is confirmed under 55

QUESTION 06

Our hypoglycemic challenge patient just had a finger stick POC BG of 59. How frequently should we be getting finger stick POC BGs?

Q 3 H

Q 1 H

Q 30 mins.

QUESTION 07

Our hypoglycemic challenge patient just had a finger stick POC Blood glucose of 49 (below our Goal). What is our next step?

Notify Phlebotomy and the Provider, draw and send whole blood with lytes

Notify Phlebotomy and the provider, draw and send serum glucose level

Notify phlebotomy and the provider, draw and send all ordered labs

QUESTION 08

After sending the whole blood with lytes and notifying the provider, what should we do next?

Contact phlebotomy and collect the rest of the ordered labs

Wait for the results to show up in EPIC.

Call the lab to tell them the whole blood with lytes has been sent and you need the results STAT.

QUESTION 09

We called the Lab and they confirmed that the patient's serum blood glucose was 48. What is the next step?

Draw and send all ordered lab levels except for the Growth hormone level

Contact and wait for Phlebotomy to collect all of the ordered lab levels

Notify the provider and wait for further instructions

QUESTION 10

How should we notify the provider about the confirmed blood glucose?

Pager

Voalte Text

Voalte Call

QUESTION 11

We collected and sent all of the ordered lab levels except for the growth hormone level. What is the next step?

Administer Glucagon

Check a POC Blood glucose

Draw and collect the growth hormone level

Next

QUESTION 12

We checked a POC blood glucose and are getting ready to administer glucagon. Select one team member to prepare the 1 ml dose of glucagon at station 3. GO!

QUESTION 13

Glucagon has been administered. How frequently are we now checking the patient's POC blood glucose?

Q 15 Mins

Q 10 Mins

Q 5 Mins

QUESTION 14

How long do you wait to collect the growth hormone level, after administering the glucagon?

40 Mins

60 Mins

30 Mins

Administer a 2nd Glucagon dose

QUESTION 15

The growth hormone level has been collected and sent to the lab. The patient's blood glucose is 65. What is the next step?

Have the patient eat.

Administer a D25 Bolus

Next

QUESTION 16

After eating your patient's blood glucose is 95. You look at the clock, its time for your other patient's blood sugar check. Draw up their diluted insulin dose at station 4. Correction Ratio is: 1:250 > 120 Current Blood Glucose: 160 No Carbs or Ketones

CONGRATULATIONS

The fourth number is:

Back to map

WELCOME TO Destination 05

Temples, tigers, and Diabetes Insipidus awaitin this land of wonders.

START

QUESTION 01

DI is when the systemic blood is ______ and the urine output is ______.

DilutedConcentrated

DilutedIncresed

ConcentratedDiluted

QUESTION 02

In DI, the blood has an increased amount of :

Calcium

Potassium

Sodium

QUESTION 03

________ is caused by an inadequate amount of Anti Diuretic Hormone (ADH) production and or storage?

NephrogenicDI

CentralDI

Primary Polydipsia

QUESTION 04

________ is caused by the kidneys' inability to respond to Anti Diuretic Hormone (ADH) ?

NephrogenicDI

CentralDI

Primary Polydipsia

QUESTION 05

________ is caused by damage to the thirst-regulating mechanisms in the hypothalamus.

NephrogenicDI

CentralDI

Primary Polydipsia

QUESTION 06

The ED provider notes that the patient appears dehydrated. Our DI patient presents to the unit with symptoms of _______ fluid intake and _______ urine output.

increased, increased

increased,decrerased

decreased,decreased

QUESTION 07

What test will be ordered to make the diagnosis of DI?

Water deprivation test

Hemoglobin A1C

Sodium Chloride Sweat Test

QUESTION 08

What unique precaution is done at the beginning of a Water Deprivation test?

The room's themostat is set on heat

The room's water pressure is increased

The room's water is completely shut off

Assess vital signs

Administer MIVF

Monitor for AMS

Collect a POC blood glucose

Collect blood work

Next

Let the pt. eat dinner

QUESTION 09

Select all that apply. The test has officially started. At the start of the water deprivation test we:

Weigh the patient

Obtain IV access

Collect a urine speciman

QUESTION 10

How frequently do we assess vital signs and obtain a pt. weight (in the same clothing on the same scale).

Q4H

Q1H

Q2H

Urine creatinine

Serum creatinine

Blood cultures

Serum Osmolality

Next

Serum Sodium

Urine Electrolytes

QUESTION 11

Select all that apply: It has been 2 hrs since the start of the test. Which labs are we collecting now?

Urine Osmolality

Urinalysis Chemical Analysis

Serum Glucose

Next

QUESTION 12

Your patient's start weight was 20 Kg. At which weight fluctuation should you notify the provider?

5% weight loss

3% weight loss

10% weight loss

< 30 sec = -2 mins < 1 min = -1.5 min > 1 min = + 2 mins

Station 5

Next

Your diapered patient has a fully saturated diaper at the 2-hour lab collection mark. Correctly collect and prepare the urine specimen as fast as you can.

00:00

Osmolality: The concentration of particles dissolved in a fluid

Urine Osmolality >1000

QUESTION 13

Which urine lab indicates diluted urine?

Urine osmolality <300

Urine Osmolality >600 at 2 time points

Serum Na > 300 and Serum Osmolality < 145

Serum Na < 145 and Serum Osmolality < 300

QUESTION 14

Accompanying a high urine osmolality (diluted urine), what Serum lab results indicate DI?

Serum Na > 145 and Serum Osmolality > 300

QUESTION 15

What medication is given to treat DI?

Insulin

TDAP

DDAVP

QUESTION 16

What do we teach caregivers to closely monitor while their child is receiving DDAVP?

Strict I/Os

Blood Glucoses

Consitency of BMs

QUESTION 17

The patient received intranasal DDAVP while they were admitted, what route of DDAVP will they likely go home with?

IM injection

Intranasal

PO/Enteral

CONGRATULATIONS

The last number is:

Back to map

TRY AGAIN?

This adventure is not over yet. What is the secret code 🔑?

27193

Fearless archaeologist, always ready for an adventure. Her whip and hat are as iconic asher bravery.

Historian and mentor, always has an interesting fact that couldsave the day.

Cunning and dangerous, she's always onestep ahead. Don't underestimateher cleverness.

A pilot with a heart of gold and a compass that always pointsto adventure.

IndianaJayne

TeacherKristen

Melanie the Treasure Hunter

CaptainChevy

Bonus: - 15 secWhat is a common cause of this alarm for infants?

Next

Next

BONUS: - 1 min What is the safe dose range? Multiply the BSA by 500mg and 1000mg BSA = 1.83

Next

Calculate a 5% weight loss for the 36 kg pt.

Bonus: -1 min

Next

BONUS: - 30 sec What is the accepted specific gravity level at which we can start the Cytoxan infusion?

Your mission, should you choose to accept it, is to solve riddles and challenges in exotic destinations to find the Treasure of Wisdom. Yes, you heard it right! Let's go for it! Choose someone to keep track of the numbers and bonus points to unlock the treasure at the end. The blitz group that completes the escape room with the quickest time will win a prize!

Next

Bonus: - 15 secWhat is our first intervention when we see a high-pressure alarm?

Welcome, adventurers! 🌍 Buckle up for an epic journeyin search of lost treasures and forgotten knowledge.Shall we go on the "Breakout Adventure"?