Abnormal lab results

[KR]

Hey all. Experienced ICU RN here. Doing agency at a super small 26 bed hospital that have worked at on and off for a while. Had a pt come up from the ER with critical lab results. Way off, like a K 1.9, Na 117, Chloride 70, etc. Pt totally asymptomatic. The MD wanted me to start giving K riders before the stat repeat labs were drawn to confirm the above results. I said no way. Not until I get my labs redrawn. Mind you, above MD told the On call lab tech he just wanted the labs redrawn in an hour or so. So lab took forever to come in. Pt still asymptomatic. Labs redrawn with levels being about the same, so my results were true and not bogus. So I gave the K riders, a total of 30mEq KCL IVPB over 3 hours. Next K was 2.2 and the MD just ordered PO KCL (only reason I know this is cause I called my unit, was working on a med surg floor for 4 hours to help them out.) Anyways, MD is pissed that I did not start the KCL right away. My experience has ALWAYS been to recheck those labs first, specially if pt is asymptomatic. I mean if a blood glucose was off the charts high or low we would recheck that. Probably will end up getting written up for that, but I stick with my decision. Just wanted some input though. TY in advance.

So what do you all think?

Sorry I am rambling. Been up way too long and hoping to pass out for a while soon.

[papawjohn]

Hey KR!!

I applaud your determination to do what you thought was right. I bet you guessed that the Dr was gonna be p@#%ed off; so your decision was particularly admirable.

Those are really weird results. I can understand why you wanted them confirmed. Treating results like that would be--in a way WORSE than giving a K-rider to someone without any Labs to go by.

Before I completely endorse your actions, I'd have to know more about the Pt and his history and--to some degree--the relationship between the Pt and the Dr before he got to the Hospital. As a Nurse who has 2 bro's-in-law who are MDs, I hear both sides. It may well be that there is some background condition or history of prev admissions that the Dr knew about but you didn't.

Of course, the communication barriers between Nurses & Docs (which are in part traditional and in part status-related...and which mostly consist of MDs not wanting to talk to US instead of we not wanting to talk to THEM) is the real problem.

Let me ask you a question: What would you have done if the Dr had calmly and politely said something like, 'Mrs KR, I've had this Pt in my care for years now. He was in the office just last week and we drew blood then that made me think this situation might be developing. I appreciate your caution but I'm not surprised that these levels have showed up and we really need to start the therapy right away.'

Now wouldn't THAT be cool? I bet you and I would have jumped right on those K-riders.

Papaw John

[dorimar, BSN, RN]

Sure would be cool PapawJohn. Too bad this is planet earth (lol)!

I would have questionsed those labs as well KR but maybe re-ordered the repeats stat.

There was an incident out here i heard about 7 years ago where the nurse was replacing K+ from an istat result. Patient later coded and k+ level (during code mind you) came back 7or 8. Now I don't know how long the patient was coding before that K was drawn, or even how long after the K+ replacements. I do know she lost her job and I don't know what other disciplinary action was taken. Lots of info is missing from this story, but just an axample of what can possibly happen with flalse lab results.

On the other hand that K was dangerously low. Nursing is a kind of damned if ya do and damned if ya don't sort of job. Funny how your license can depend on how fast someone else (lab) decides to do their job.

[PICC ACE]

I would have dragged my feet until I got a confirmation on the labs. The key point in your post--"pt is asymptomatic". Labs are only numbers. Great looking labs from a patient that looks like crap means you still have a patient that looks like crap,totally messed up labs from a patient that looks great is something entirely different.

[Nieuport]

Hope PaPaw is a professor at a Medical University!!! Honest! If I had an MD talk to me like that, I'd likely never question him/her again! But, yeah, Picc, I, too, like looking at the pt and not the equipment...........so as an instructor once said (regarding the constant changes in therapies)....."We don't know anything, but we're very nice people and we mean well!" !

[dfk, RN, CRNA]

...........so as an instructor once said (regarding the constant changes in therapies)....."We don't know anything, but we're very nice people and we mean well!" !

i don't quite know what that statement is supposed to mean.. it is almost a polite condescending one, one that i take mild offense to.. i wouldn't want to hear this from my instructor, or anyone for that matter. it is our job/responsibility to keep up with the changes, and lack thereof is part and parcel our own fault. i work hard at maintaining skills and knowledge, and would expect nothing less from others :angryfire

just my sound-off cents -

[Nieuport]

All she meant was that things we do or the ways we do them are constantly changing. What we may currently think is the absolute right thing for our pts, some research may come along tomorrow and say "OMG, we shouldn't have been doing that at all!"

[dfk, RN, CRNA]

All she meant was that things we do or the ways we do them are constantly changing. What we may currently think is the absolute right thing for our pts, some research may come along tomorrow and say "OMG, we shouldn't have been doing that at all!"

OK

[goodluckbear]

Great job!! K is not something you mess w/. It takes guts to go against a doctors order. You acted as an advocate for your patient and they will be thankful to have you as their nurse.