Dominguez Nursing
Mental Health Specialist

Escape Mood

 

Mood Disorders Escape Room

Escape the Unit

You are the RN team caring for Hannah during her inpatient mood-disorders admission. Clear the mania locks, review the depressive history that shapes her risk, and finish the handoff before the shift clock runs out.

Every station needs three keys: a clinical call, a digital clue, and an approval code earned after your worksheet checkpoint is reviewed.

Clinical call Digital clue Approval code
Unit Progress 0 of 8 locks solved
  • Triage Bay
  • Safety Huddle
  • Ladder
  • Med Cart
  • Blue Room
  • Risk Scan
  • Hotline
  • Handoff
Evidence Theater

Video Intel

Use these clips when a station tells your team to review the case, symptoms, or medication clues.

Case Clip

Hannah's Bipolar Case Introduction

Useful before Locks 1 and 2.

Concept Clip

What Is Depression?

Useful before Locks 5 and 7.

Concept Clip

DSM Understanding Mood Related Disorders

Useful when your team needs a symptom refresher.

Pharm Clip

Pharmacology Overview for Bipolar

Useful before Lock 4.

Quick Reference

Use These Before You Guess

The fastest teams keep one eye on the patient data and one eye on the clinical judgment process.

Clinical Judgment

Six-Step Loop

  1. Recognize cues: notice the relevant data.
  2. Analyze cues: connect what belongs together.
  3. Prioritize hypotheses: decide what matters first.
  4. Generate solutions: choose the safest plan.
  5. Take action: do the nursing work.
  6. Evaluate outcomes: decide if the patient is safer now.
Safety Lens

What Beats Speed

  • Safety of self and others is always the top priority.
  • Acute mania and suicide risk outrank teaching and discharge planning.
  • Least restrictive first: verbal, milieu, chemical, seclusion, mechanical restraints.
  • When suicide risk is possible, ask directly and escalate quickly.
Medication Radar

Classes To Watch For

  • Lithium: mood stabilizer with serum monitoring.
  • Anticonvulsants: valproate, carbamazepine, lamotrigine.
  • Second-generation antipsychotics: risperidone, olanzapine, quetiapine.
  • Third-generation antipsychotics: aripiprazole, brexpiprazole, cariprazine.
  • Benzodiazepines: alprazolam, lorazepam, clonazepam for acute anxiety or agitation.
  • SSRIs/SNRIs: common antidepressant classes used in depression care, with extra caution during mania.
Lock Rules

What Counts As Cleared

  • Each station has two on-screen parts and one worksheet checkpoint.
  • The approval code only works after your worksheet section is checked.
  • Do not move on until the station opens and the next one unlocks.
  • If your team stalls, go back to the evidence and reference lab before guessing.
Case Stations

Clinical Locks

Clear all three keys at each station: the clinical call, the digital clue, and the approval code.

Room 1 / Recognize Cues

Lock 1: Triage Bay

3 keys required

Hannah was admitted after five days of very little sleep, risky spending, and escalating behavior. Build the first lock by finding the clearest manic evidence from her inpatient admission.

Chart Snapshot

  • Slept 2 to 3 hours per night for five days and reports feeling "fully charged."
  • Purchased expensive camera gear at 3:00 a.m. for a "global empire launch."
  • Speech is rapid, loud, and difficult to interrupt.
  • Frequently changes topic when hallway noises occur.
  • Paces the dayroom and interrupts peers' conversations.

Mental Status Fragment

"I do not need sleep. I have a gift and the whole city is about to notice."

Use Hannah's case-study video if your team wants one more symptom example before deciding.

Part 1

Clinical Call

Pending

Select the six cues that best support mania.

Part 2

Digital Clue

Pending

Map each chart fragment to the clue bucket it fits best.

"Two hours of sleep and still fully charged."
"Global empire launch."
3:00 a.m. spending spree on expensive gear
Topic changes every time a hallway sound appears
Part 3

Worksheet Checkpoint

Waiting

Build your own manic chart note. With your team, create one mock mental status exam for a client experiencing mania that is different from Hannah's case-study video from the beginning of class.

Make it feel chart-ready: include appearance and behavior, speech, mood and affect, thought process, thought content, insight and judgment, sleep pattern, and one safety concern.

Need a quick refresher?
  • Strong mania cues include decreased sleep, pressured speech, distractibility, grandiosity, risky behavior, and overactivity.
  • Shopping sprees and foolish investments belong in the "clear evidence" pile, not the background-data pile.
Room 1 / Prioritize Hypotheses

Lock 2: Safety Huddle

3 keys required

Hannah is now on the unit. Build the safest first-five-minute nursing plan before you move on.

Part 1

Clinical Call

Pending

Which hypothesis takes priority first in the acute phase?

Part 2

Digital Clue

Pending

Select the four immediate milieu moves that help lower stimulation and risk.

Part 3

Worksheet Checkpoint

Waiting

Your team has two worksheet jobs for this station.

Job 1: For each client statement below, decide which neurotransmitter cue is showing up. Use dopamine, serotonin, or norepinephrine.

  • "I am the luckiest man alive."
  • "Are you married? You are very attractive. Let's hook up."
  • "Let's all go outside and run. It is a beautiful day out!"

Job 2: Review the five manic patient summaries below. For each patient, draw one Maslow hierarchy and place one patient problem at each level you can defend. Mark the most important and least important problem, and leave self-esteem blank since it is usually inflated in these cases.

Open the 5 patient summaries
  1. Alicia, 33, has slept maybe 1 hour a night for 4 days and says meals waste valuable time. She keeps trying to slip out the unit doors because she believes she has an urgent meeting with city leaders. She screamed at her sister during visiting hours and accused her partner of sabotaging her success. She insists she has to quit nursing school tonight because she is destined to run a national wellness empire.
  2. Marcus, 41, has been awake for 72 hours, has only eaten chips from the vending machine, and now says his body does not need rest. He stands on chairs in the dayroom to preach to strangers and nearly falls each time staff redirect him. His wife stopped answering his calls after he drained their savings account to start a cryptocurrency church. He says regular work is beneath him because he has discovered his "real purpose" as a global spiritual leader.
  3. Tiana, 28, has not slowed down long enough to finish a meal in two days and is drinking coffee nonstop instead of water. She darts into other patients' rooms looking for people to join her new clothing business and becomes furious when staff block the doorway. Her mother says Tiana has alienated most of her friends this week with nonstop calls, oversharing, and angry texts. Tiana says she no longer needs her apartment or job because she will be famous by the weekend.
  4. David, 52, reports feeling "too powerful to sleep" and has spent the last three nights pacing the halls. He refuses meals because chewing takes too long, and staff notice he is becoming shaky and dehydrated. He attempts to leave the unit to drive to another state and buy land with money he does not have. His adult children refuse to visit because he has threatened them and called them disloyal. He says he must abandon his family responsibilities to launch the invention that will "fix the whole country."
  5. Rosa, 36, has slept less than 2 hours each night for five days and has lost weight because she will not sit long enough to eat. She tries to climb onto the nurses' station desk to make announcements to the unit and keeps reaching for other patients' belongings. Her roommate and best friend both asked for space after Rosa accused them of jealousy and tried to recruit them into a risky investment. Rosa says everyday life is over for her because she is about to become the face of a new international movement.
Need a quick refresher?
  • Acute phase care focuses on safety first, not teaching first.
  • A low-stimulation environment, short directions, and predictable limits are part of supportive bipolar care.
Room 1 / Generate Solutions

Lock 3: De-Escalation Ladder

3 keys required

Build the least-to-most restrictive ladder exactly the way it should happen on the unit.

Part 1

Clinical Call

Pending

Order the interventions from least restrictive to most restrictive.

Use calm, concise verbal redirection and consistent limit setting.
Reduce stimulation, move to a quieter space, and shape the milieu.
Give ordered medication for escalating agitation or loss of control.
Use seclusion only if less restrictive strategies fail and safety is threatened.
Apply mechanical restraints only as a last resort according to policy.
Part 2

Digital Clue

Pending

Match each scenario to the response level that fits it best.

Client is pacing but responds to one-step redirection.
Client settles after moving to a low-stimulation room.
Ordered PRN medication is needed for escalating agitation.
Client cannot be safe in the open unit after less restrictive efforts fail.
Immediate physical danger continues during a violent assault.
Part 3

Worksheet Checkpoint

Waiting

Draw four upside-down pyramids on your worksheet. Each pyramid must have three levels: verbal, milieu, and chemical, with one intervention written at each level.

For Patients 1 to 3, title the pyramid: "I am trying to... prevent exhaustion." For Patient 4, title it: "I am trying to... stabilize safety."

Open the 4 patient scenarios
  1. Patient 1 has been awake for 4 nights, talks through every group, forgets to drink water, and insists sleep is for people with no ambition.
  2. Patient 2 keeps pacing the hallway while planning five businesses at once, refuses to sit down for meals, and becomes irritated when staff suggest a break.
  3. Patient 3 keeps volunteering for every activity on the unit, starts exercising in the dayroom, and says rest will make the "creative energy" disappear.
  4. Patient 4 is entering peers' rooms, grabbing supplies off the nurses' station, shouting over staff, and becoming physically intimidating when redirected.
Need a quick refresher?
  • Use the least restrictive option that still keeps the patient and staff safe.
  • The ladder on this page follows the exact class order: verbal, milieu, chemical, seclusion, mechanical.
Room 1 / Take Action

Lock 4: Medication Cart

3 keys required

Stabilize the med cart by using the blister packs from your evidence bag, then decide what the lithium clues are trying to tell you.

Open the specimen cup chart clue
  • The simulated specimen in your evidence bag is dark amber.
  • Fluid intake this shift is estimated at only 600 mL.
  • The patient had vomiting and diarrhea after a hot weekend.
  • Dry mucous membranes and worsening tremor are documented in the chart.
Part 1

Clinical Call

Pending

Use the blister packs from your evidence bag. Match each medication to the best role or caution point in this bipolar case.

Lithium
Mood stabilization and suicide-risk reduction.
Citalopram
Common SSRI that deserves extra caution if mania is active.
Risperidone
Atypical antipsychotic option often used in mania.
Alprazolam
Short-term calming medication, not a long-term mood stabilizer.
Part 2

Digital Clue

Pending

Match each lithium scenario to the pattern it most strongly suggests.

Patient missed several doses this week, mania symptoms are ramping back up, and says the medication "got annoying."
Patient has dark amber urine after a hot weekend, drank very little water, had vomiting and diarrhea, and now feels shaky and nauseated.
Patient has coarse tremor, vomiting, slurred speech, and an unsteady gait.
Patient is mood-stable, hydrated, and coming in for routine lab follow-up with no red-flag symptoms.
Part 3

Worksheet Checkpoint

Waiting

Build a lithium warning card on your worksheet.

  • Using the blister packs, explain why Hannah might have lithium, citalopram, risperidone, and alprazolam in the chart.
  • Name which medication should make you pause if mania is active and say why.
  • List two reasons a level might be low.
  • List two reasons a level might be rising or high.
  • List at least four symptoms of lithium toxicity.
  • Write the first nursing action if toxicity is suspected.
Need a quick refresher?
  • A level can climb when a patient is dehydrated, losing sodium, or not taking in enough fluid.
  • Lithium toxicity concerns rise when symptoms move beyond a mild fine tremor into coarse tremor, vomiting, diarrhea, confusion, slurred speech, or ataxia.
  • An SSRI like citalopram may show up in a bipolar medication history, but active mania should make your team pause and think carefully.
  • Use the pharmacology video if your team wants one more medication overview before submitting.
Room 2 / Recognize Cues

Lock 5: Blue Room

3 keys required

During Hannah's inpatient admission, the team learns about a severe depressive episode from a few months ago. Use the evidence bag to separate depression cues from warning signs that suggest suicide concern.

Shift Report

  • Stopped painting and no longer attends church activities she used to enjoy.
  • Sleeps 12 to 14 hours a day and still reports exhaustion.
  • Has eaten very little and lost 8 pounds in two weeks.
  • Says, "My family would be better off without me."
  • Takes a long time to answer and struggles to focus on questions.

Nursing Note

Hannah says a few months ago she became deeply depressed, tried to give treasured belongings to her boyfriend, and later insisted the feelings had passed. She brought the same items to the hospital today with a green tag that says "precious belongings."

Use the photo note, UV light, and scratch ticket from your evidence bag during Part 2. Use the depression video if your team wants a quick symptom refresher before sorting the evidence.

Part 1

Clinical Call

Pending

Select the seven cues that best support major depression with suicide concern.

Part 2

Digital Clue

Pending

Use the photo note, UV light, and scratch ticket from your evidence bag. What phone number is Hannah leaving behind? Enter digits only.

Part 3

Worksheet Checkpoint

Waiting

Show your list of five depression criteria, two suicide warning clues, and one sentence explaining why the "precious belongings" evidence worries your team before entering the approval code.

Need a quick refresher?
  • CASE can help your team remember neurovegetative clues: concentration, appetite, sleep, and energy.
  • Key depression clues in your source materials include anhedonia, fatigue, sleep disturbance, appetite change, guilt, poor concentration, and thoughts of death.
  • Giving away valuables, writing "just in case" messages, or preparing important accounts for others can push concern toward suicide preparation.
Room 2 / Analyze Cues

Lock 6: Suicide Screen

3 keys required

The green tag and follow-up updates from Hannah's history suggest the situation may be moving from background risk into active warning signs. Sort the evidence before the situation worsens.

Part 1

Clinical Call

Pending

Sort each clue into the category that fits best.

Previous suicide attempt last year
Heavy alcohol use on weekends
Supportive boyfriend willing to remove medications, sharp objects, and stay present
Can clearly name reasons to live and agrees to collaborate with treatment
Hands over a green tag labeled "precious belongings" and says her boyfriend should keep everything safe for her
Asks staff whether someone can help her write or notarize a living will today
After weeks of hopelessness, becomes suddenly calm and says, "Soon this will all be easier for everyone."
Increasing social isolation after a recent death in the family
Part 2

Digital Clue

Pending

Decode part of the SAD PERSONS screen by matching letters to factors.

S
D
P
O
N
Part 3

Worksheet Checkpoint

Waiting

Show your suicide-risk worksheet with at least three risks, two protective factors, and three warning signs identified.

Need a quick refresher?
  • Warning signs are more urgent than background risk factors because they suggest the patient may be closer to acting.
  • Giving away precious belongings, asking about a living will, or becoming suddenly calm after weeks of despair should make your team move faster.
  • Protective factors matter, but they do not erase risk.
Room 2 / Prioritize Assessment

Lock 7: Hotline Window

3 keys required

When Hannah's safety is uncertain, the next question matters. Get the question right, then build the next four moves.

Part 1

Clinical Call

Pending

Which assessment question is the priority right now?

Part 2

Digital Clue

Pending

Select the four immediate follow-up moves that belong right after a "yes" answer.

Part 3

Worksheet Checkpoint

Waiting

Show your suicide assessment script with at least four follow-up questions or actions. One teammate may be asked to do a 20-second finger-puppet version.

Need a quick refresher?
  • Asking directly does not create suicidality. It clarifies risk.
  • Once risk is present, move fast toward plan, means, intent, and safety support.
Final Station / Clinical Judgment Synthesis

Lock 8: End-of-Shift Handoff

3 keys required

Finish the shift by connecting the clinical judgment loop to the outcomes you actually want to see.

Part 1

Clinical Call

Pending

Match each clinical judgment step to the best nursing move.

Recognize cues
Analyze cues
Prioritize hypotheses
Generate solutions
Take action
Evaluate outcomes
Part 2

Digital Clue

Pending

Select the four findings that show the unit is actually becoming safer.

Part 3

Worksheet Checkpoint

Waiting

Submit your final handoff worksheet with one priority, one intervention, and one evaluation point for Hannah's acute mania needs and one priority, one intervention, and one evaluation point for Hannah's depressive and suicide-risk history.

Need a quick refresher?
  • Clinical judgment is a loop: notice, connect, prioritize, plan, act, reassess.
  • An outcome only counts if the patient is safer or functioning better than before.
Exit Bay

Shift Locked Down

You cleared every station by using clinical judgment, not just spotting vocabulary words. Hold onto your worksheet packet for the final class debrief.

What Your Team Proved

  • You can separate mania from depression using cue clusters.
  • You can prioritize safety before teaching or discharge planning.
  • You can think in least-restrictive steps and reassess outcomes.

Bring To Debrief

  • Your completed worksheet packet
  • The hardest lock your team solved
  • One medication class and one safety intervention you want to remember