10 Lab Values PDF

8. Lab Values **Must know and also how to PRIORITIZE them!!** A= ABNORMAL ! Do Nothing ○ A = LOW priority B= BE CONCERNED ! Assess/Monitor ○ B = LOW priority, but be concerned (watch them) C= CRITICAL ! Do Something ○ C = HIGH priority...

8. Lab Values **Must know and also how to PRIORITIZE them!!** A= ABNORMAL ! Do Nothing ○ A = LOW priority B= BE CONCERNED ! Assess/Monitor ○ B = LOW priority, but be concerned (watch them) C= CRITICAL ! Do Something ○ C = HIGH priority; critical/do something!! *you CAN leave the bedside* D = DEADLY DANGEROUS ! Do Something NOW ○ D = HIGH priority; extremely critical!! *you can NOT leave the bedside* MEMORIZE the 5 D’s!!! ( the 5 you really NEED to KNOW!!) HIGHEST PRIORITY PATIENTS ○ pH in the 6s ○ Potassium in the 6’s ○ Co 2 in the 60s ○ O2 in the 60’ s ○ Platelet count LESS than 40,000 LEARN all the C’s & what to do!!! (about 8-10) When should you call the rapid response team? ○ When the patient is symptomatic ○ Assess them and then call CREATININE ( serum): BEST factor to determine RENAL function Normal Range: 0.6-1.2 Elevated: Level A ○ If elevated it's abnormal but not too worrisome (jut mean kidney are failing) ○ *FYI* the only time you should contact the DOC because of a HIGH level creatinine, is if the pt is going for a test/procedure (the next morning) that involves a DYE; but it is not priority to let them know (it can wait until 6am/7am). INR: Monitors coumadin therapy ( Anticoagulant) Therapeutic level: 2-3 ○ ↑ INR = bleeding risk Level C: level > 4 (critical) ○ Do something: (1) always HOLD, (2) ASSESS ( focuses assessment on area) (3) PREPARE to administer Vitamin K (4) CALL doc/respiratory/etc. Example: (click & drag)... level of 4.7 = HOLD coumadin, ASSESS for bleeding, PREPARE to give vitamin K, CALL doc! -sometimes there’s nothing to HOLD, so jump to ASSESS.. sometimes there’s nothing to PREPARE, so jump to CALL - but you should always go through the process in your mind, so you don’t miss a step. POTASSIUM: An indicator that something is wrong Normal Range: 3.5-5.3 Level C: Hypokalemia 6 Cardiac Danger Zone ○ Deadly serious; pt could DIE, in like the next 2 minutes HOLD all potassium ASSESS the heart PREPARE kayexalate, D5W & regular insulin CALL doc *** STAT!!! get everyone involved & YOU stay with your PT*** pH: Normal Range: 7.35-7.45 ○ As pH does, so does my patient K+ can increase which could stop the heart Level D: pH in the 6’s (ex: 6.8) ○ ASSESS the VITALS immediately ○ CALL doc & get them there STAT !! Can also call rapid response team Don’t give sodium bicarbonate to acidotic patients, treat underlying cause of the acidosis BUN ( blood urea nitrogen): Nitrogen waste products in the blood Normal Range: 8-25 Level B: elevated ○ If, HIGH, no BIG deal - ASSESS pt for DEHYDRATION ○ *FYI* If they give you an elevated blood value & you have NO clue what’s going on; & they ask for what would you assess them; DEHYDRATION is a good answer. Hemoglobin: Normal Range: 12-18 Level B: 8-11 ○ ASSESS for anemia (bleeding or malnutrition) Level C: < 8 ○ Do something! ASSESS for bleeding, PREPARE to administer BLOOD CALL doc. Bi-carb (HCO3): Chemical buffer that keeps the pH of blood from becoming too acidic or too basic Normal Range: 22-26 Level A: Abnormal, don’t worry! CO2: Carbon dioxide; getting from an arterial blood gas Normal range: 35-45 Level C in the 50s: ○ *Talking about people WITHOUT COPD!!* ○ ASSESS respirations, ○ PREPARE: have patient do pursed lip breathing Pursed lip breathing (PLB) is the breathing technique that consists of exhaling through tightly pressed (pursed lips) and inhaling through nose with mouth closed.... This should FIX problem; so you shouldn’t have to CALL doc. Level D: in the 60’s ○ Respiratory FAILURE  ASSESS respiratory status PREPARE for INTUBATION/VENTILATE CALL respiratory therapy first, then CALL the doc. (YOU stay with YOUR pt!!!) Hematocrit: Normal range: 36-54 ○ 3x the hemoglobin; 12-18 Level B: elevated hematocrit ○ ASSESS for dehydration pO2: From arterial blood gas; not pulse ox! Normal Range: 78-100 Level C: 70-77 Respiratory insufficiency ○ ASSESS for respiratory status ○ Give them OXYGEN !! (do not need an order) FYI: when a pt is HYPOXIC: which rate increases first? respiratory rate or heart rate ? ○ Heart rate will increase first then the respiratory rate will go up FYI: if you ever work CORONARY care, what are the 2 most common causes of episodic tachycardia in heart pt’s? HYPOXIA & DEHYDRATION Level D: < 60s Respiratory failure ○ Give oxygen ○ ASSESS respiratory status ○ PREPARE for INTUBATION/VENTILATE ○ CALL RT and doc ○ Example: (click & drag question): THROW on O2, ASSESS, PREPARE to intubate/ventilate & then call respiratory/doc.. **NCLEX TIP: 80 % of the time, you always assess before you do anything.. 20% of the time you need to hold something before you assess. An example where this is not true, if if you had a blood transfusion going on and the patient was complaining of itching... You would STOP the infusion & then assess the pt! ASSESS before you DO, UNLESS delaying DOING puts your pt at higher risk! BEST vs. FIRST question... BEST: administer O2, FIRST: raise head of bed ○ If you have to pick between doing two things: do the position thing first than the other O2 Sats: Normal Range: 93-100 Level C: Anything < than 93 ( for NCLEX!!) ○ In real life, be HAPPY with 88 & >!! ○ ASSESS respirations & throw on O2! ○ For PEDIATRICS; FREAK out if the kid goes BELOW 95!!! FYI: What invalidates for SaO2? ○ Anemia will falsely elevate SaO2 ○ Dye procedure in the last 48 hours *These patients will look better than they actually are according to their SaO2 BNP: Brain Natriuretic Peptide → BEST indicator for CHF; chronic condition Normal Range: < 100 Level B: elevated Sodium: Normal range: 135-145 Level B: abnormal ○ ASSESS! HIGH = ASSESS for dehydration LOW = ASSESS for overload Level C: *If the question says that the level is abnormal & there is a change in the LOC ○ Safety Issue WBC: Normal Range: ○ *Total WBC: 5,000-11,000 ○ *ANC (absolute neutrophil count): NEEDS to be ABOVE 500 ○ *CD4 count: NEEDS to be ABOVE 200 When CD4 is below 200 → this is when HIV goes into AIDS Level C: when all of these values are below normal ○ ASSESS for signs of infection & place them on NEUTROPENIC precautions! Neutropenic Precautions: Strict handwashing Shower BID with antimicrobial soap Avoid crowds Private room Limit number of staff entering the room  Limit visitors of healthy adults No fresh flowers or potted plants Low bacteria diet: ○ No raw fruits, vegetables, salads ○ No undercooked meat Do not drink water that has been standing longer than 15 minutes Vital signs (temp) every 4 hours Check WBC (ANC) daily Avoid use of indwelling catheter Do not reuse cups..must wash in between use Use disposable plates, cups, straws, plastic knife, fork, spoon Dedicated items in room: stethoscope, BP cuff, Thermometer, Gloves ○ Terminology: High WBC count → Leukocytosis Low WBC count → Leukopenia, Neutropenia, Agranulocytosis, Immunosuppression, Bone marrow suppression Platelets: Thrombocyte clotting cell Normal Range: 150,000-400,000 Level C: < 90,000 ○ ASSESS for bleeding ○ Bleeding precautions ○ CALL doc Level D: < 40,000 ○ Could spontaneously hemorrhage to death ○ ASSESS for bleeding ○ Bleeding precautions ○ PREPARE for transfusion ○ CALL doc Bleeding Precautions (Thrombocytopenic Protocol): ○ No unnecessary venipuncture-injection or IV. Use small gauge ○ Handle patient gently; use draw sheet ○ Use electric razor ○ No toothbrush or flossing ○ No hard foods ○ Well fitting dentures (no rub) ○ Blow nose gently ○ No rectal temp, enema, suppository ○ No aspirin ○ No contact sports ○ No walking in bare feet  ○ No tight clothes or shoes ○ Use stool softener. No straining ○ Notify MD of blood in urine, stool RBC: Normal Range: 4-6 million Level B: abnormal count ○ Check for bleeding