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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

00:00

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

We cannot infuse IV mag to patients with an AMS

Try Again

We cannot infuse IV mag to patients younger than 2 y.o. or that are having worsening respiratory distress

Try Again

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

Try Again

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

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

Which fluids run concurrently with IV Magnesium?

QUESTION 03

Try Again

Headache

Hypotension

Nausea and Vomiting

What is the most common side effect of IV Mag?

QUESTION 04

Try Again

QUESTION 05

If wrong, +10 secs to end time

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

Try Again

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

Try Again

Renal

CBC with Diff

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

QUESTION 05

Specific Gravity

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

Try Again

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 06

Try Again

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

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(π‘š2 ) = √(β„Žπ‘’π‘–π‘”β„Žπ‘‘ Γ— π‘€π‘’π‘–π‘”β„Žπ‘‘) Γ·3600

Next

Wrong answers: + 10 sec. to total time

Correct answer: 1.83

Next

Correct answer: 915 mg - 1,830 mg

Next

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 04

Try Again

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 04

What else should you do?

What else should you do?

Try Again

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

The line does not get flused

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

Phew, pharmacy delievered a new bag and the Cytoxin is finally infused. Now how do we flush the line?

PREGUNTA 04

Try Again

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 04

Nephrotoxicity

Acute kidney injury

Hemorrhagic Cystitis

After cytoxan infusions we encourage patients to stay hydrated, frequently (Q2h) urinate, and perform Qvoid specific gravity checks to monitor for what common side effect?

PREGUNTA 04

Try Again

IVIG

Ditropan

Mesna

What medication is administered to prevent hemorrhagic cyctisis that infuses over 16 hours post cytoxan?

PREGUNTA 04

Try Again

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

PIP

PEEP

CP

What term is used to measure the highest amount of pressure reached during inspiration?

QUESTION 01

Peak Inspiratory Pressure

Next

Try Again

The amount of pressure held in the lungs at the end of expiration

The amount of pressure held in the lungs at the start of expirtation

What does PEEP measure?

QUESTION 01

The amount of pressure held in the lungs at the end of inspiration

Next

Postive End Expiratory Pressure

Try Again

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

Try Again

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 01

Try Again

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 01

The Ventilator

Try Again

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 01

Pressure Control(PC)

Try Again

CPAP

BiPAP

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

QUESTION 01

Try Again

CPAP

BiPAP

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

QUESTION 01

Try Again

to adjust the vent settings to what is ordered

to take the pt. off the vent to suction

to give pt. a 100% breath

Which is NOT the responsibilty of the Nurse while caring for a patient on a bipap or vent?

QUESTION 02

to put the pt. back on the vent after suctioning

Try Again

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 03

Try Again

The vent is disconnected

The vent is not able to provide adequet pressure

There is not an adequet exhalation leak

QUESTION 03

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

Try Again

You really need to find that RT

The pt. cannot inhale enough volume

The pt. cannot exhale enough volumne

The vent is now alarming Low Vte (exhaled tidal volume), what does this mean?

QUESTION 03

Try Again

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 minute ventilation measure?

QUESTION 03

Try Again

Step 1) Assess the Patient

The vent is alarming low Vte, the patient is alert and oriented, SpO2 is 74%. As a team, at the desitantion 3 station, verbalize and demonstrate the next steps you would take if you saw this alarm.

QUESTION 03

Step 3) 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

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 01

Try Again

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 02

Try Again

Wronganswer

Correct answer

Wronganswer

What is the nameof the lost oasis?

QUESTION 03

Back to map

9

The fourth number is:

CONGRATULATIONS

START

Temples and tigers awaitin this land of wonders.

WELCOME TO Destination 05

Correct answer

Wronganswer

Wronganswer

Which god must behonored to move forward?

QUESTION 01

Wronganswer

Correct answer

Wronganswer

What is the secret ingredientof the elixir?

QUESTION 02

Wronganswer

Wronganswer

Correct answer

What mountain hides thelast treasure?

QUESTION 03

Back to map

3

The last number is:

CONGRATULATIONS

TRY AGAIN?

CONGRATULATIONS!

If the entire dose was given, the line may be disposed of in the general trash.If there is bulk medication left in the bag, the bag and line needs to be placed in a HM bag and put in the red pharmacy bin. Pharmacy also needs to be notified.+5 seconds

Next

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.

BONUS: Calculate your safe dose range.Multiply the BSA by 500mg and 1000mgReward: -30 secs off total time

Next

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

Correct answer: Spec Grav < 1.010

Next

If the entire dose was given, the line may be disposed of in the general trash.If there is bulk medication left in the bag, the bag and line needs to be placed in a HM bag and put in the red pharmacy bin. Pharmacy also needs to be notified.+ 5 seconds

Next

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!

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

Bonus:What is our next intervention?Reward: -10 sec

check patient first-trach plugged, increased secretions/mucous plug, chest rise (is it equal bilaterally)

Next

Next

Bonus:What is a common cause of this alarm with infants?Reward: -15 sec

(disconnected, trach cuff deflated, loose connection in circuit, patient behaviorβ€”mouth open)

Blankets covering the exhalation valve.

Next

Bonus:How do we figure out minute ventilation value?Reward: -15 sec

RR x Exhaled tidal volume = MV