Which of these labs should be done for all new admissions? - page 2

Cbc sma7 pt hemogram cmp urinalysis fasting specimens ptt urine c& s ekg... Read More

  1. 2
    Depending on your facility......these can be considered "standing orders". Nurses do this all the time in the ER in Triage. I am not sure what your state allows for LPN's and admissions/initial assessment and what the requirement is......so would check with your facility policy and nurse practice act. What kind of facility is this? I would ask your manager/charge nurse what is the standard protocol for these admission for this MD.

    LABS should be individualized on assessment/history of the patient, on a patient to patient basis. I would be sure your state allows LPN's to do thisand I would request the policy that dictates how this policy is to be followed and by whom.

    CBC: Common admit lab if differential needed
    sma7: common admit lab
    PT: order if patient is on anti-coagulants
    hemogram: short version of CBC, less expensive, H&H without the Differential
    CMP: Comprehensive Metabolic profile.....extended version of SMA
    urinalysis: routine admission order
    fasting specimens: What fasting specimens are performed?
    PTT: again order if patient is on any anti-coagulants.
    urine c& s: many facilities do these these days to document whether or not a patient is admitted with UTI
    EKG: Clinically done on patients with cardiac history....MI, CABG, Pacemakers, Angina etc.
    rhythm strip: a peek at a patients rhythm if cardiac issues present.
    SoldierNurse22 and BSNbeDONE like this.

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  2. 1
    We had standing orders for labs AFTER MD saw them. Usually BMP, CBC w/diff, PT/INR if on coumadin and u/a w/ c&s.
    BSNbeDONE likes this.
  3. 2
    Quote from Jory
    I hope that isn't a real question.

    Labs should only be drawn and focused on what the patient complaint is. To do anything else is just running unnecessary labs and wasting resources.
    I agree. When I worked in the hospital our clinical nurse specialist and nurse practitioner would go nuts about rotating residents who came over from the adult hospital and wanted to order "routine labs" on everyone who was admitted.

    In answer to the OP, I would say "none of the above." You do labs based on MD orders and the patient's condition, not just because they present to a facility.
  4. 1
    IMH(umble)O, none of the above, unless it is well-known what's the purpose of the order. Although it is different in real life, sure. It is named "double-defensive medicine" - both helps against ambulance-chasing lawyers, and also against inherently uncompliant patients who for whatever reason used to question orders and potentially interfere with hospital's profits.
    GrnTea likes this.
  5. 2
    If your docs want to have what amounts to a cookie-cutter medical plan of care for every admit, your facility is free to have one, so long as it is signed off by the appropriate therapeutics committee. But do NOT order labs yourself without such backup.
    jadelpn and nursel56 like this.
  6. 0
    *nevermind* Someone already said the same thing.
  7. 0
    I work in family med. we have lab protocols that we use, if person is diabetic they get a b c labs if they have hypertension they get c d f labs and so on. If pt has no medical dx and are healthy just want their yearly physical we can order CBC cmp And lipid as long as they are over 30, anyone under 30 we have to provider orders. If anyone falls outside or protocol (HIV or other dx we don't normally manage) then we must get provider orders.
  8. 1
    There's a difference between standing orders for every pt getting the same labs drawn and you ordering the right labs on a case-by-case basis. I had a working interview and was offered the job with an office very close to home, paying what I wanted, in the specialty I wanted, and turned it down. The doc would complain to the MAs (and me if I was to be the LPN hired) about the MA not ordering a CT Angiogram on a pt with c/o headaches and missing the diagnosis! I reminded him that nurses and MAs do not diagnose and we certainly don't order CT scans! Then again, the MAs would make up vital signs on new pts so I'm not really sure if anything was right. (And by making up vital signs, I mean the MA would ask new pts if they have BP problems or if it's normally good, if pt says yes, then MA would enter a value of 120/70--no BP cuff needed!) I'm just waiting on Medicare to audit that place. . .
    KelRN215 likes this.
  9. 0
    Depends on why they are admitted. But CBC is always a good choice.

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