Can you identify the significance of abnormal lab values in relation to patient care?

zenman · Apr 6, 2006

I want to know the significance of abnormal lab values in relation to patient care. As an example, what to look for in a patient? What are the symptoms? What to do? Please help..I have a lab test, nursing implications text book but the information is very brief and does not go into detail about pancreatitis..Can any experienced nurse help me? Thank you.

Remember that as a nursing student, google.com is your best friend. Here's the first listing I found under "pancreatitis."

http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/

southern rn · Apr 6, 2006

My patient has pancreatitis...The abnormal lab values are
ALT: 80 High
Normal values: 7-56
Significance: Used to diagnose and monitor treatment of liver disease
AST: 47 High
Normal values:15-46
Significance: Pancreatitis
Lipase: 345 High
Normal values: 23-300
Significance: Pancreatitis
I want to know the significance of abnormal lab values in relation to patient care. As an example, what to look for in a patient? What are the symptoms? What to do? Please help..I have a lab test, nursing implications text book but the information is very brief and does not go into detail about pancreatitis..Can any experienced nurse help me? Thank you.

Hi, quick answer for you,almost times to get the kids ready for school.Pts with pancreatitis will typically present with nausea/vomiting, abd pain. Some general malaise. The lab values you quoted while elevated are relatively mild elevations. Need to watch for dehydration,treat abd pain, etc. Typically are given ivf's and prn pain/nausea meds,npo or liquid diet while watching labs. Can be caused by etoh intake, gallstones/duct stones, and some meds.

Hopefully someone can elaborate more for you. Good luck!

mtnmom · Apr 6, 2006

In pancreatitis the primary labs to watch for elevation are amylase and lipase. The liver enzymes you showed were only mildly elevated.

I would be curious what the pt's amylase level was.

Also, sometimes acute pancreatitis can be associated with high...I mean sky high....triglycerides. Another reason to keep the triglycerides down.

P_RN, ADN, RN · Apr 6, 2006

Merck manual is/was my dearest friend for lab values.

http://www.merck.com/mrkshared/mmanual/tables/296tb2a.jsp

labman · Apr 6, 2006

Bala

Thank of the organs they are affecting. ALT and AST both pertain to the liver. When I think of care of the patient and elevated liver enzymes I immediatly think of medication. If there liver can't really process the medication that well a lower dose of the medication should be given (pretty sure). These elevations both say that there are liver problems but not major ones. I know hepatitis has really high values so I think this would be before pain. Also a pancreatitis. I know that people with pancreatitis usually have abdominal pain. So plan to do frequent pain assessments q 1 hour or something. But also how the pancreas helps in the GI system. It secrets bicarb and enzymes to help with digestion. So maybe a change in dietary habits. I wished I knew the exact change but I just have no idea.

I hope this helps a little

KENT

Editorial Team / Admin · Apr 6, 2006

My patient has pancreatitis...The abnormal lab values are
ALT: 80 High
Normal values: 7-56
Significance: Used to diagnose and monitor treatment of liver disease
AST: 47 High
Normal values:15-46
Significance: Pancreatitis
Lipase: 345 High
Normal values: 23-300
Significance: Pancreatitis
I want to know the significance of abnormal lab values in relation to patient care. As an example, what to look for in a patient? What are the symptoms? What to do? Please help..I have a lab test, nursing implications text book but the information is very brief and does not go into detail about pancreatitis..Can anyone help me? Thank you.

Hello, Bala Shark,

Check out this article from eMedicine. Very good w/u regarding pancreatitis.

http://www.emedicine.com/emerg/topic354.htm

Spatialized · Apr 6, 2006

As for pancreatitis, just did a teaching presentation for class on this so it's still fresh. The labs aren't too bad, they're in the normal high range. Here's what I can recall at the moment.

ALT & AST

LFTs, usually elevated in ETOH abuse, hepatitis, somewhat inpancreatitis (due to inflammation of the pancreas). However these can be elevated for many different reasons. Things I would be looking for on a pt. w/elevated LFTs would be anorexia, jaundice, abd. distention r/t ascites, to name a few.

Lipase

Not the major pancreatitis marker. Again, normal high range, seen folks with much higher. Some meds can cause elevation too.

The big one with pancreatitis is amylase.

But I realize you're trying to correlate lab values with pt. assessment. Once you understand the labs, you an start knowing what to look for. For example, on the tele floor where I work, we watch K all the time. If you have an elevated or decreased K, you know to watch for arrhythmias due to increased irritability of the heart. A great resource I found that made the labs click is: http://www.icufaqs.org/. Check out his section on labs as he ties in lab values and assessments findings.

Good luck!

Tom

Bala Shark · Apr 6, 2006

Hi, quick answer for you,almost times to get the kids ready for school.Pts with pancreatitis will typically present with nausea/vomiting, abd pain. Some general malaise. The lab values you quoted while elevated are relatively mild elevations. Need to watch for dehydration,treat abd pain, etc. Typically are given ivf's and prn pain/nausea meds,npo or liquid diet while watching labs. Can be caused by etoh intake, gallstones/duct stones, and some meds.
Hopefully someone can elaborate more for you. Good luck!

Yes, I know what lipase, AST, ALT does..And you gave the signs and symptoms of pancreatitis..On paper, should I write the signs and symptoms and can I say, that the patient has high lipase values that show pancreatits then I will discuss the signs and symtoms of pancreatitis to the patient...Is that a good way of approaching it?

leslie :-D · Apr 6, 2006

if you're going strictly by your pt's labs, i would guess the pt is asymptomatic. as already stated, the labs are rather unremarkable.

leslie

leslie :-D · Apr 6, 2006

On paper, should I write the signs and symptoms and can I say, that the patient has high lipase values that show pancreatits then I will discuss the signs and symtoms of pancreatitis to the patient

you can't dx pancreatitis just based on elevated lipase levels.

lipase levels can be elevated with pancreatitis, obstx, carcinoma, gallbladder, liver and even renal. good luck.

leslie

Daytonite, BSN, RN · Apr 6, 2006

Bela,

If you are only going to look at the lab value and then attempt to determine what your patient care is going to be based on those lab values alone, then you want to know all about each lab test. In the PM I sent you I also sent you links to online information on each of those three tests. The website will also tell you why the doctor would be ordering those tests. In other words, what diseases is the doctor looking to eliminate in the differential diagnosis of this patient's condition. So, yes, you would want to list those diseases. In the case of these three specific tests, I would look for the same diseases which will show up for all three. We already know that pancreatitis is one of them. But there may be others. I'm thinking of hepatitis. You then need to take that list of diseases and make a list of the symptoms of those diseases. From those symptoms you will be able to develop a list of nursing interventions. You already know that a patient with pancreatitis is going to have abdominal pain, nausea, and/or vomiting, fever. What is the nursing care going to be for those things? Analgesics perhaps? IV fluids? NPO? Or, what other kind of diet? Measurements of Intake and Output? Positioning for comfort? What frequency of vital signs? If patient is febrile, what might be given? How else can you make a febrile patient comfortable? What other tests would you anticipate the doctor will order? Will there be any special preparation that you will need to know for those tests? Does that make it a little clearer for you?

You have to understand that this stuff is not as cut and dry as I think you want to make it. There is a lot of overlapping. You have to look at the lab, look at the anatomy and physiology, look at the disease process, anticipate the doctor's orders, and amid all that develop your list of nursing actions or plan of care. This stuff is all related. It all has to be put together to form it's own little story from beginning to end. There are a lot of "if's" because you never really ever know exactly what is going on unless you have gotten definitive statements of diagnosis from the doctor.