I need help identifying why my patient's lab values are abnormal!

[tmusicc]

So i was taking care of a patient in the ICU who was diagnosed with a hygroma after recently receiving a craniotomy (about a month ago) for the resection of an epidermoid tumor in the skull. He is currently intubated and on ventilation. He is sedated with a RASS score of -4. He is on NPO status. He also has a external ventricle drain actively draining CSF at a pop-off of 0. He is on the following medications:

-Fentanyl

-Propofol

-Fosphenytoin

-Haloperidol

-Phenytoin

-Ziprasidone

-Famotidine

Ive explained most of his abnormal lab, but I am troubled on the following ones:

-Potassium of 3.1 (Normal 3.5-5)

-Creatinine of 0.7 (Normal 0.9-1.3)

-Calcium of 7.9 (Normal 8.5-10.1)

-Phenytoin of 9.8 (Normal 10-20)

I would really appreciate it if anyone could help me interpret these results. thanks in advance.

[RNNPICU, BSN, RN]

To point you in the right direction..

1. Look up each of the drugs and look up Side effects and interations, etc

2. Look up his diagnosis and surgery. In your nursing books there are nursing implications,

3. Draw a stick figure of your patient. Start with the head and go down. Put your lab results to the side and point arrows to the areas you think they might affect.

It will help you start to make the connections

[AgentBeast, BSN, RN]

None of those labs mean much of anything. The K+ is slightly low because well the K+ is slightly low. The same thing with Ca++. Who really cares about a low creatine? The Dilantin level is slightly sub-therapeutic and so the patient needs a slightly higher dose, or not since it's not so far out of whack to really matter much.

[tmusicc]

yes all of the labs are not too much out of range to mean much of anything but I am doing a paper for nursing school and I am required to explain why these lab values are abnormal. Since they are so minimally out of range, i am having a tough time explaining them.

[RNNPICU, BSN, RN]

yes all of the labs are not too much out of range to mean much of anything but I am doing a paper for nursing school and I am required to explain why these lab values are abnormal. Since they are so minimally out of range, i am having a tough time explaining them.

It should be concerning that the labs are out of range.

Try looking up what can cause low K and look at your patient diagnosis/history, current status?

As a Nurse you would need to act on those values. Really, just take a look at the bigger picture and see.

[NICUmiiki, DNP, NP]

Creatinine of 0.7 is normal in my facility, but if it still concerns you, you can look up what decreased levels could be caused by. They probably make sense given the patients condition.

The phenytoin lab is only useful in someone who is taking it. My phenytoin lab would be around 0 (abnormal? no). So, if someone takes phenytoin, then their phenytoin lab is low, what does that mean? Why would you want to check this lab?

Potassium & Calcium. How do they enter the body? How do they leave the body? What body systems maintain the correct levels? Are any of these impaired?

[Bumex, DNP, NP]

Look up corrected calcium levels and albumin. If you don't have this patients albumin level at hand, at least speculate why this patient may have a ca of 7.9. Also, look to see how they are being fed. Are they on tube feedings? Tpn? This can possibly account for electrolyte imbalances as well. Creatinine that low is most often unimportant. But what is creatinine? What is it the product of? Why might someone have more or less in the serum?

[KelRN215, BSN, RN]

There's not really any such thing as a "low" creatinine. You want your patient's creatinine to be

Your patient is NPO. He needs K+ containing fluids or adjustments in his TPN, if he's on TPN.

Dilantin level is slightly below the therapeutic threshold but, if he's not having seizures, it may be a fine level for him. If he is, his dose needs to be increased slightly.