A7C Adventure Breakout

CHARACTERS

MISSION

Introduction

START

AdVENTURe

A7C BREAKOUT

Destination 01

Destination 02

Destination 03

Destination 04

Destination 05

CHOOSE YOUR DESTINATION

START

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!?

WELCOME to Destination 01

Start stop watch on phone.

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

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

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

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

QUESTION 01

A

B

C

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

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

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

What is the standard dosing for IV magnesium for asthma?

QUESTION 02

A

B

C

False

True

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

QUESTION 03

A

B

False

True

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

QUESTION 04

A

B

False

True

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

QUESTION 05

A

B

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

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

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

Which fluids run concurrently with IV Magnesium?

QUESTION 06

A

B

C

Headache

Hypotension

Nausea and Vomiting

What is the most common side effect of IV Mag?

QUESTION 07

A

B

C

QUESTION 08

If wrong, +10 secs to end time

Stop the infusion and NS bolus.

Nothing that is a normal BP

Notify the Team to come Bedside STAT

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?

QUESTION 09

A

B

C

2

Back to map

The first number is:

CONGRATULATIONS

START

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

WELCOME TO Destination 02

Low(Green)

Moderate (Orange)

High (Red)

Cytoxan is idetenified as what level of hazardous medication?

PREGUNTA 01

A

B

C

PREGUNTA 02

Rationale

\

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.

Wrong: +10 secs to end time

Next

Midline

PICC

PIV

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

PREGUNTA 03

A

B

C

Renal

CBC with Diff

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

QUESTION 04

Specific Gravity

A

B

C

Next

BONUS: What is the accepted specific gravity level that we can start the Cytoxan infusion? Reward: 30 seconds off your over all time!

Administer the ordered anti-emetic pre-med

Administer the ordered tylenol pre-med

Calculate the patient's BMI

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

QUESTION 05

A

B

C

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

Hint will cost you +20 secs

Next

What is their BSA?

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.

B𝑆𝐴(𝑚2 ) = √(ℎ𝑒𝑖𝑔ℎ𝑡 × 𝑤𝑒𝑖𝑔ℎ𝑡) ÷3600

Next

Wrong answers: + 10 sec. to total time

Correct answer: 1.83

Next

Correct answer: 915 mg - 1,830 mg

Next

5%

10%

15%

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

PREGUNTA 07

A

B

C

In the MAR comments

In the Cytoxan Infusion Verification Flowsheet

In the Chemotherapy Nurse Verification Flowsheet

Where do we document the cytoxan verification in EPIC?

PREGUNTA 08

A

B

C

00:00

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.Reward:dressed in < 30 sec= 1 min off total timedressed in < 1 min = 20 sec off total timedressed in < 1.5 mins = 10 sec off total time

Next

Obtain a Chemo spill kit and follow the directions

Put a yellow absorbent mat over it and call EVS

Call 803-Safe

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

PREGUNTA 09

What else should you do?

Next

A

B

C

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

Nothing

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

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

PREGUNTA 10

A

B

C

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

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

Throw it in the trash

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

PREGUNTA 11

A

B

C

Nephrotoxicity

Acute kidney injury

Hemorrhagic Cystitis

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

PREGUNTA 12

A

B

C

Q 2H

Q 1H

Q 8H

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

PREGUNTA 13

A

B

C

Qvoid UAs

Q4H/Qvoid Urine Specific Gravity checks

Qvoid Urine Assessment

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

PREGUNTA 13

PO hydration encouragement

Bedrest

Next

Caffine Limitiation

48 hours

16 hours

24 hours

PREGUNTA 14

A

B

C

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

IVIG

Ditropan

Mesna

What medication is administered to prevent hemorrhagic cystitis post cytoxan?

PREGUNTA 15

A

B

C

24 hours

16 hours

8 hours

How long does Mesna take to infuse?

PREGUNTA 16

A

B

C

Back to map

7

The second number is:

CONGRATULATIONS

START

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

WELCOME TO Destination 03

A set pressure is provided during inspiration

A set tidal volume is provided during inspiration

A set pressure is provided during expiration

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

QUESTION 01

A

B

C

A set pressure is provided during inspiration

A set tidal volume is provided during inspiration

A set tidal volume is provided during expiration

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

QUESTION 02

A

B

C

Either the pt. or the vent

The Patient

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

QUESTION 03

The Ventilator

B

C

A

Assist Control(AC)

Synchronized intermittent Mandatory Ventilation(SIMV)

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

QUESTION 04

Pressure Control(PC)

A

B

C

CPAP

BiPAP

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

QUESTION 05

CPAP

BiPAP

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.

QUESTION 06

CPAP

BiPAP

Which setting can provide a higher pressure?

QUESTION 07

to adjust the vent settings to what is ordered

To ensure the exhaliation valve is clear of obstruction

to give pt. a 100% breath

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

QUESTION 08

to put the pt. back on the vent after suctioning

A

B

C

D

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

You need to call the RT to fix the vent

There is an airway resistance or plug

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

QUESTION 09

A

B

C

Their is a plug in the trach

The vent is unable to provide adequate pressure.

There is not an adequate exhalation leak.

QUESTION 10

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

A

B

C

You really need to find that RT

The pt. cannot inhale enough volume

The pt. cannot exhale enough volume

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

QUESTION 11

A

B

C

The pt. is not meeting their ventiliation settings

Pt. has a decreased RR

Pt. has a decreased exhaled tidal volumne

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

QUESTION 12

A

B

C

Step 1) Assess the Patient

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

QUESTION 13

Step 3) Call for help and change the trach

Step 4) Assess the vent and circut

Step 2) Assess the airway

Step 5) Call code Blue and manually bag the patient

Back to map

1

The third number is:

CONGRATULATIONS

START

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

WELCOME TO Destination 04

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

QUESTION 01

IV

Next

False

True

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

QUESTION 02

Q 30 mins.

Q 1 H

Q 3 H

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

QUESTION 03

A

B

C

Q 30 mins.

Q 1 H

Q 3 H

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

QUESTION 04

A

B

C

Qvoid once BG is confirmed under 55

Qvoid once their BG is confirmed under 70

Qvoid until thier first void post hypoglycemia

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?

QUESTION 05

A

B

C

Q 30 mins.

Q 1 H

Q 3 H

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

QUESTION 06

A

B

C

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

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

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

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

QUESTION 07

A

B

C

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

Wait for the results to show up in EPIC.

Contact phlebotomy and collect the rest of the ordered labs

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

QUESTION 08

A

B

C

Notify the provider and wait for further instructions

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

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

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

QUESTION 09

A

B

C

Voalte Call

Voalte Text

Pager

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

QUESTION 10

A

B

C

Draw and collect the growth hormone level

Check a POC Blood glucose

Administer Glucagon

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

QUESTION 11

A

B

C

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 4. GO!

QUESTION 12

Next

Q 5 Mins

Q 10 Mins

Q 15 Mins

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

QUESTION 13

A

B

C

30 Mins

60 Mins

40 Mins

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

QUESTION 14

A

B

C

Administer a D25 Bolus

Have the patient eat.

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

QUESTION 15

A

B

C

Administer a 2nd Glucagon dose

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 insulin dose at station 5.Correction Ratio is: 1:250 > 120Current Blood Glucose: 160No Carbs or Ketones

QUESTION 16

Next

Answer: 2 Units

Back to map

9

The fourth number is:

CONGRATULATIONS

START

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

WELCOME TO Destination 05

ConcentratedDiluted

DilutedIncresed

DilutedConcentrated

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

QUESTION 01

A

B

C

Sodium

Potassium

Calcium

In DI, the blood has an increased amount of :

QUESTION 02

A

B

C

Primary Polydipsia

CentralDI

NephrogenicDI

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

QUESTION 03

A

B

C

Primary Polydipsia

CentralDI

NephrogenicDI

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

QUESTION 04

A

B

C

Primary Polydipsia

CentralDI

NephrogenicDI

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

QUESTION 05

A

B

C

decreased,decreased

increased,decrerased

increased, increased

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

QUESTION 06

A

B

C

Sodium Chloride Sweat Test

Hemoglobin A1C

Water deprivation test

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

QUESTION 07

A

B

C

The room's water is completely shut off

The room's water pressure is increased

The room's themostat is set on heat

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

QUESTION 08

A

B

C

Collect a urine speciman

Obtain IV access

Weigh the patient

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

QUESTION 09

Let the pt. eat dinner

Next

Collect blood work

Collect a POC blood glucose

Monitor for AMS

Administer MIVF

Assess vital signs

Q2H

Q1H

Q4H

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

QUESTION 10

A

B

C

Serum Glucose

Urinalysis Chemical Analysis

Urine Osmolality

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

QUESTION 11

Urine Electrolytes

Serum Sodium

Next

Serum Osmolality

Blood cultures

Serum creatinine

Urine creatinine

10% weight loss

3% weight loss

5% weight loss

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

QUESTION 12

Next

A

B

C

00:00

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.

Next

Station 5

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

Urine Osmolality >600 at 2 time points

Urine osmolality <300

Which urine lab indicates diluted urine?

QUESTION 13

Urine Osmolality >1000

A

B

C

Osmolality: The concentration of particles dissolved in a fluid

Serum Na > 145 and Serum Osmolality > 300

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

QUESTION 14

Serum Na < 145 and Serum Osmolality < 300

Serum Na > 300 and Serum Osmolality < 145

A

B

C

DDAVP

TDAP

Insulin

What medication is given to treat DI?

QUESTION 15

A

C

B

Consitency of BMs

Blood Glucoses

Strict I/Os

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

QUESTION 16

A

C

B

PO/Enteral

Intranasal

IM injection

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

QUESTION 17

A

C

B

Back to map

3

The last number is:

CONGRATULATIONS

TRY AGAIN?

CONGRATULATIONS!

CaptainChevy

Melanie the Treasure Hunter

TeacherKristen

IndianaJayne

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

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

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

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

Next

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

• The vent is disconnected
• trach cuff deflated
• loose connection in the circuit
• patient behavior—mouth open

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

Next

Bonus: -1 min

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

Next

-1.8 kg or 34.2 kg

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

Next

Correct answer: Spec Grav < 1.010

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!

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

Next

Check the patient first! Then see if the trach is plugged:

• Suction out increased secretions/mucous plug
• Look for ventilation - chest rise (is it equal bilaterally)

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