Nursing Exam Review Lecture 8 Lab Values

Lecture 8 You will be asked to prioritize different pts based on lab values Therefore, it is not good enough to simply know the normal/abnormal lab values You would have to rank or prioritize pts based on abnormally critical lab values Use the “ABCD” scheme to prioritize pt based on lab values • Low priority o A is low priority … This lab result can be ignored for a few hours or, if late at night, until very early morning o B is concerning … This lab result needs to be closely monitored • High priority o C is critical … You need to do something The RN does the first set of assessments for this lab for Levels C or D … Example: V/S, lung o D is highest priority … Stay at the bedside and heart auscultations, abdominal exam, Lab Values (05:11) Lab Creatinine (Cr) INR Best indicator of kidney or renal function etc. Range 0.6 to 1.2 “ABCD” Scheme Level A Level B if dye procedure (such as a catheterization) is involved Level C when 4 and above Monitors coumadin … Also 2 to 3 reflects PT (or Prothrombin time) • Action to take in following order … Hold Coumadin ! Focus Assessment for bleeding ! Prepare to give vit K ! Call HCP Potassium (K+) Blood chemistry 3.5 to 5.3 Level C if Low Level C if High Level D if over 6 • LOW potassium … Action to take in the following order … Nothing to hold ! Assess heart (EKG) ! Prepare to give K+ ! Call HCP • HIGH potassium (bet 5.4 and 5.9) … Action to take in the following order … Hold K+ ! Assess heart (EKG) ! Prepare to give Insulin/Kayexelate ! Call HCP • HIGH potassium (6 or more) … Action to take in the following order … Hold K+ ! Assess heart (EKG) ! Prepare to give Insulin/Kayexelate STAT ! Call HCP, stay with pt pH Blood chemistry 7.35 to 7.45 Level D if pH in the 6s • Action to take … Nothing to hold ! Assess V/S ! Nothing to prepare ! Call HCP BUN Waste product in blood 8 to 25 Level A (Blood urea nitrogen) • Action to take … Nothing to hold ! Assess for dehydration ! Prepare IV fluid ! Call HCP Hemoglobin (Hb) Blood 12 to 18 Level B if 8 to 11 Level C if <8 • Action to take for a Level C … Nothing to hold ! Assess for bleeding/anemia/malnutrition ! Prepare blood ! Call HCP Bicarbonate 22 to 26 Level A CO2 Level C if in the 50s Level D if in the 60s or higher • Action to take for a Level C … Nothing to hold ! Assess for breathing ! Ask pt to perform purse-lipped breathing ! Call HCP o This is not a COPD pt • Action to take for a Level D … Nothing to hold ! Prepare to intubate/ventilate ! Call (Respiratory therapy ! HCP), do not leave pt o This is respiratory failure Hematocrit (Hct) Assess for dehydration 36 to 54 Level B O2 or PaO2 Blood chemistry 78 to 100 Level C if 70 to 77 Level D if in the 60s or lower, respiratory failure • Action to take for a Level C … Nothing to hold ! Assess for respiration difficulty and dyspnea, prepare to give oxygen ! Call HCP o In a pt with hypoxia, the heart rate increases first, then the respiratory rate increases afterwards due to compensation o In a coronary care unit, the 2 most common episodic causes of tachycardia in heart pt are hypoxia and dehydration Treatment: Give the O2 to pt and increase the rate of fluid administration usually solve the problem • Action to take for a Level D … Prepare to intubate/ventilate pt ! (Call Respiratory therapist ! HCP), stay with pt O2 Saturation 93 to 100 Level C if <93 • Action to take for a Level C … Nothing to hold ! Give pt O2 • What invalidates your reading? o Anemia o Or a Dye procedure—It colors the blood o Both falsely elevated BNP B >100 indicates CHF. Monitor <100 Level B if >100 (Brain natriuretic pt for sign of CHF peptide) Sodium (Na) Electrolyte 135 to 145 Level B if abnormal Level C if abnormal and there is change in pt’s LOC • Action to take for a Level B … Nothing to hold ! Assess for fluid overload (hypOnatremia) or dehydration (hypERnatremia) ! Prepare for furosemide (hypOnatremia) or IV fluid (hypERnatremia) ! Call HCP • If there is a change in LOC, pt becomes level C and a safety issue WBC Total 4,000 Level C <4,000 to 11,000 ANC (Absolute >500 Level C <500 neutrophil count) CD4 >200 Level C <200 • CD4 >200 but <500 is HIV • CD4 <200 is AIDS • Action for WBC, ANC and CD4 … Assess and put on pt neutropenic precautions o Refer to neutropenic precautions below Platelet (PLT) 150,000 to Level C if <90,000 450,000 Level D if <40,000 RBC 4 to 6 million Level B if abnormal (Red blood cell) Platelet and RBC (Continued onto Lecture 9) Neutropenic Precautions • Strict hand washing • Vital q4 hrs • Dedicated stethoscope, BP cuff • Reverse/protective isolation • Shower BID with microbial soap • Avoid crowds • Private room • Limit staff/visitors • No fresh flowers/potted plants • No raw fruits/veggies/undercooked meat • No water pitcher standing for over 15 minutes • Check WBC daily • No indwelling catheters • Do not reuse cups or disposable plates Five Deadly “Ds” • The following are 5 priority pts based on their lab values • The NCLEX exam will not put one of the followings against another o K+ >6 o pH in the 6s o CO2 in the 60s o pO2 <60 o Platelets <40,000