help with labs

Jill2Shay · Sep 5, 2013

Did you get a health history from him?

Esme12, ASN, BSN, RN · Sep 5, 2013

I'm having a hard time figuring out what my patients lab may indicate. This semester we are expected to explain if abnormal labs are a sign of worsening, improving, or stable conditions. This is the first time i have been on a cardiac unit and so I'm finding it very difficult to explain what my patients labs mean. I have looked in the lab book that I have and searched online trying to understand the significance of some of the lab results i recorded, but I'm just not sure if I'm right about some of my conclusions. SO my patient had a somewhat low H&H and RBC, and high PTT and troponin, also low potassium and high cholesterol. I know what the results mean I just don't know what's causing them to be increased/decreased. My patient was there due to a NSTEMI, was taking lipitor, lopressor, aspirin, tylenol, nitroglycerin patch, had a heparin drip at 25ml/hr with NS running as well. He was scheduled for a coronary angiography. This is pretty much the only information I could find about my patient other than the fact that he had a headache, but was no longer having any chest pain. He had been there for two days when I took care of him. His VS were all normal. I really want to understand this and would appreciate if someone could help me a little.

Lab Tests Online: Welcome! is a great resource.

We are happy to help.....tell us what you think first and we will join in to help you find the right track.

SO my patient had a somewhat low H&H and RBC, and high PTT and troponin, also low potassium and high cholesterol.

Put your thinking cap on and Look at your patients history....what causes an elevated cholesterol? Did the elevated cholesterol have anything to do with his heart attack? If so then what? Is this patient on any cholesterol lowering drugs and are they new to this admission? If not then what would the patient need to do to lower their cholesterol?

Why would this patient have an elevated PTT? Are there any medicines that this patient is taking at the present time? How does that apply to his diagnosis for this admission?

How low is the H&H? Was there a CBC done with differential? What is the breakdown? Depending on the results and how low would lead you to why they are low. How fast is the NS IV? Could this be dilutional?

Why is the K+ low? How low? Why is this significant to a new NSTEMI? Has the patient been given any diuretics during his hospital stay?

Tell me what you think and we will go from there.......

nurseprnRN, BSN, RN · Sep 5, 2013

One of the best resources for this sort of dilemma I have ever seen is the classic Laboratory and Diagnostic Tests with Nursing Implications, by Joyce Lefever Kee. I forget what edition is current, but they'll have it on Amazon.

Just what it says-- has great info on, at the most basic level, why we care about results, how to think about preps for tests, and all sorts of useful pearls. Guaranteed to help you out on these questions. Mine is on my desk right now.

mlauren · Sep 5, 2013

This is what I have so far. Hopefully I'm not too far off with these.

This patient had a somewhat low Hgb and Hct. This could be due to increased fluids diluting the blood. It doesn’t necessarily indicate that the patient’s condition is worsening, but could cause the heart to work harder if too low and increase the chances of death after a heart attack. They both went up to normal levels on day of care, so I would say the patient is remaining stable and the levels are just a little low due to dilution. (H&H 13.3 & 38.5)

This patient had an elevated PTT of 117 on 9/3, which would mean that the heparin dose needed to be held. But on 9/4 it was lower so the heparin drip was continued. And the results indicate that it is working like it should to keep the blood from clotting, helping to reduce further blockage of the arteries. (PTT 67.4)

High cholesterol, triglycerides, and low HDL could have contributed to his heart attack and having them still at a high level can put this patient at risk for another one so that should continue to be treated. (Chol 142, HDL 25L, Total chol 5.7H, Triglycerides 152H)

This patient’s potassium levels were low, which is important because low potassium can cause ventricular arrythmias. I don’t think that it indicates the condition is worsening, because it wasn’t extremely low. (K+ 3.7)

The troponin level is important in determining the amount of damage to the heart. The patient’s levels were high so it indicates that there was some damage done. If the levels increased more in the next several hours I would say the condition was worsening, but troponin tends to stay elevated up to a couple of weeks after a heart attack. (troponin 12.10)

mlauren · Sep 5, 2013

Oh and the history I have is hypertension, high cholesterol, cholecystectomy (2002), CABGX6 (2002), appendectomy, and GERD. Other than this I don't know a whole lot. I didn't get to spend a huge amount of time interviewing my patient, because it was sort of an orientation day as well. And this is what my instructor provided me with. This patient was 58 yrs old, male.

nurseprnRN, BSN, RN · Sep 5, 2013

mlauren, you done good. Not so bad, once you put it all together, is it? (Why was his K+ worth continued watching? You're right about the ventricular arrhythmias, but what makes it go down, other than dilutional (not a significant issue c K+)?

:flwrhrts:

Esme12, ASN, BSN, RN · Sep 5, 2013

Nice job.......So let look at this....

This is what I have so far. Hopefully I'm not too far off with these.

This patient had a somewhat low Hgb and Hct. This could be due to increased fluids diluting the blood. It doesn’t necessarily indicate that the patient’s condition is worsening, but could cause the heart to work harder if too low and increase the chances of death after a heart attack. They both went up to normal levels on day of care, so I would say the patient is remaining stable and the levels are just a little low due to dilution. (H&H 13.3 & 38.5).....could this have anything to do with chronic ASA therapy?

This patient had an elevated PTT of 117 on 9/3, which would mean that the heparin dose needed to be held. But on 9/4 it was lower so the heparin drip was continued. And the results indicate that it is working like it should to keep the blood from clotting, helping to reduce further blockage of the arteries. (PTT 67.4) Heparin doesn't reduce further blockage in the arteries......it does however make the blood "slippery" so it doesn't develop more clots in arteries already blocked...right? Look up how heparin works.

High cholesterol, triglycerides, and low HDL could have contributed to his heart attack and having them still at a high level can put this patient at risk for another one so that should continue to be treated. (Chol 142, HDL 25L, Total chol 5.7H, Triglycerides 152H) so he would benefit from a med change and diets instruction

This patient’s potassium levels were low, which is important because low potassium can cause ventricular arrythmias. I don’t think that it indicates the condition is worsening, because it wasn’t extremely low. (K+ 3.7) what else can cause a low potassium....could it have anything to do with injury/strain of the myocardium????

The troponin level is important in determining the amount of damage to the heart. The patient’s levels were high so it indicates that there was some damage done. If the levels increased more in the next several hours I would say the condition was worsening, but troponin tends to stay elevated up to a couple of weeks after a heart attack. (troponin 12.10)....WOW....Decent troponin......the trending of the troponin indicate the presence active myocardial activity/damage or the extension of the MI

mlauren · Sep 6, 2013

Thank you all! The aspirin can cause anemia in some patients so that could be contributing to the low h&h as well. But I'm not sure what you're getting at with the potassium.

mlauren · Sep 6, 2013

Ok at first I had #1 decreased cardiac output, #2 impaired skin integrity (because of the angiography) an #3 acute Paine (because the angina). But now I'm thinking #2 should be altered tissue perfusion rt atherosclerotic processes (because of the high cholesterol) and #3 risk for bleeding (because he is on heparin). Does that sound like a better care plan to follow? I mean those are the most important issues to make interventions for especially since this patient wasn't in pain anymore on the day I cared for him. And I feel like the interventions for impaired skin integrity could go under risk for bleeding, because they're mainly about making sure the site doesn't bleed and caring for it.

Jill2Shay · Sep 6, 2013

What were his ABGs?

Just curious, I'm only in block two and they've drilled into us that alkalosis decreases K+.

mlauren · Sep 6, 2013

I'm not sure. I didn't see any ABGs on his chart. But I wondered the same