Critical lab


I was at work and got report at 7pm from the day shift. A client had an order for iv fluids which were not started. So after counting and report for 2 halls, with multiple issues left for me that the previous shift did not do, I started problem solving. I could not get an IV in this patient. They said they tried 3 times.

So, I called R.M. to see if they could come and get one in. They stated that the previous nurse called at 2pm and then never called back. My report wasn't complete until 8pm. I got the file out while waiting for RM. The order for IVF was written at 11:15 am. It was for 0.45% NS. I decided to keep going and looked for a lab. The lab said Na166 Critical in bold. So no wonder I couldn't get a IV, but RM had a tough time. This order was for 11:15, this is now 12 hrs later that I started the IVF. What is the time from to follow thru with the IVF. The other shift tried to blame it on me, but, it was 8pm when I took over, which is 9 hrs after the order was written.

I read that a Na>150 has a mortality of 75%.

Thanks, D.


34 Posts

Specializes in Geriatric Psychiatry. Has 3 years experience.

I believe that the MD ordered the fluids for the time it was wrote. So if I were the nurse the IV fluid would be running by 1215 all medications must be given within an hour of the order in my state including IV fluids. Now if I have difficulty gaining access I would notify the Doctor (I have had this happen). Ask what they want to do, usually we send them out if we cant gain access and the lab is critical.

If I had been the nurse leaving I would have never dumped that in your lap. I would stay until I got the order complete. Sorry you had to deal with that. Next time let your doctor know though!!!!! That would cover your back.

CapeCodMermaid, RN

6,089 Posts

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Our docs know that many of the residents are difficult sticks. They assume we'll start the IV fluids when we get the line started. That said, the day shift should have done more than they did.


437 Posts

Specializes in Neurosciences, stepdown, acute rehab, LTC. Has 8 years experience.

No I agree with psychgeri... If the doc was not yet made aware of the critical lab and the difficult stick I would have called, despite the docs assuming that you may not get a stick right away. If I was a day shift nurse , I probably would have already called, or at least told you about the lab and stayed to see if you could get the IV in, and if not, I would have personally called and got you some orders before I left.

edit: oh I read your last post wrong , I thought you meant that the day shift did all they could. Yea I agree with you.