Lab Values Explaination

Focus on the abnormals.

Look at your white count; its high, right? What causes your WBC to rise? your pt has an infection....

Elevated BUN with a normal Creat can be because of dehydration; why might your pt be a little dry? He's not feeling well, trying to fight infection, ....is he taking in enough po fluids? eating? getting IV fluids? running a fever? decreased urine output?

Hgb and Hct a little low..maybe be normal or abnormal for this pt, could possibly always be a little anemic secondary to poor nutrition or could have a slow bleed somewhere (Usually GI) Look through pt's records/old charts to see if these values have changed significantly since last hospital visit.

Glucose a little high; glucose can rise in response to stress. What could be stressing your pt's body? Infection, resp distress....

Also check your meds book. Some meds cause abnormal lab test results as well.

Do you have a laboratory diagnostic book? For our clinicals we have to look up every abnormal lab for our patient, list what will cause the lab value to increase/decrease, s/s that would accompany an increased/decreased value, and treatment for the increased/decreased value. Then you have to indicate what information out of all of that applies to your patient. It's time consuming (last week I had 32 labs I had to research), but when you get it all down on paper (or the computer screen) it's really easy to see why your patient has these labs results and what it means for them.

THanks everyone for the suggestions!

Lab confusion....

Hey A-D-G-N

First of all, the explanation above about the way that pneumonia relates to the WBC count and etc is a really really good one. And the advice to 'look it up' should be followed. But I have to tell you that lots of experienced Nurses have the same problem relating lab values to the Pt's condition, to what lab values should have to do with each other, what nursing interventions they should lead to--well, it's hard for lots of us.

The problem starts with the way we don't know how to organise all those numbers. It turns into mumbo-jumbo real quick; just look at all the numbers jammed together that you put on your original post. To start with, you don't need all those numbers--just some of them.

Here's how I show 'baby nurses' how to do it:

1. Draw a straight line across a sheet of paper horizontally. On the top of that line draw two short vertical lines. (Make three spaces on the first line.)

Then on the bottom, draw three short verticals (make four spaces).

Along the top of the line, use the three spaces to fill in the Sodium, Chloride and Glucose. Along the bottom, Potassium, Bun, Creatinine and CO2.

Look what you've got: Above the line-an IVFluid (see it? Na Cl Dextrose, like D5 1/2 NS). Below the line you've got a report on your Pt's kidneys.

Let's put your Pt's lab values in this form:

Na 133 I Cl 100 I Gl 142 (little low on saline-needs electrolytes)

K 5.3 I BUN 40 Cr 1.5 I CO2 22 (kidneys stressed, moderately dehydrated)

The Pt needs saline and fluid; maybe 1/2 NS at 75 to 125/hr. Does he have a good IV site? Has the Dr seen these labs? Is the IV order appropriate? If he's not eating & drinking you need to see that these things are done. If he's taking PO well, move the water pitch off his over-bed table and put juices there.

See how looking at the labs should suggest nursing action?

2. Do a similar 'formatting' of the CBC: (You'll see the Drs doing this in the progress notes, BTW--that's how I learned it)

Again, draw a line but this time put two 'wedges' on either end of it. Like this:

>-----

And put the WBCs in the left wedge and the PLT in the right wedge and the HGB above the line in the middle, and the HCT below it. (For our purposes, we don't need to know the 'differential' of the WBCs. For general information--its basically an set of percentages (so it should add up to 100) of how young or old the WBCs are. This indicates how hard the body is working churning out WhiteBloodCells.)

So this is what we get for your Pt:

9,8

15.5>------------

28.9

So your guy has a slight elevation of his WBCs but as NeneRN said, you're not surprised by this cause his diagnosis is of an infection. Infact, for a Pt with pneumonia--that's kind of low WBCs. So maybe his infection is low level, or somewhat chronic. You'd relate this to other things you see--is his temp WNL? What's his heart rate? What's his O2 sat? Does he have a productive cough? What do his lungs SOUND like? Etc, etc.

Then with this effective grasp of the data, you can plan Nursing Care. You want to make sure that his mild anemia does not get worse (probably he'd get a unit of blood if his Coronary Artery Disease is bad and his HGB went below 9.0). You want O2 Sats as high as possible because the fewer-than-normal RBCs have to carry their maximum amount of Oxygen to his heart.

So the labs play a part in making a science-based plan of care for your Pt, IF YOU CAN USE IT. And now you CAN!!! WAY TO GO!!!!

Yer ol'

Papaw John

John,

Thanks so much for the great explanation. I made a copy of this and plan to start using this method myself. Super tip!

Lab confusion....

Hey A-D-G-N

First of all, the explanation above about the way that pneumonia relates to the WBC count and etc is a really really good one. And the advice to 'look it up' should be followed. But I have to tell you that lots of experienced Nurses have the same problem relating lab values to the Pt's condition, to what lab values should have to do with each other, what nursing interventions they should lead to--well, it's hard for lots of us.

The problem starts with the way we don't know how to organise all those numbers. It turns into mumbo-jumbo real quick; just look at all the numbers jammed together that you put on your original post. To start with, you don't need all those numbers--just some of them.

Here's how I show 'baby nurses' how to do it:

1. Draw a straight line across a sheet of paper horizontally. On the top of that line draw two short vertical lines. (Make three spaces on the first line.)

Then on the bottom, draw three short verticals (make four spaces).

Along the top of the line, use the three spaces to fill in the Sodium, Chloride and Glucose. Along the bottom, Potassium, Bun, Creatinine and CO2.

Look what you've got: Above the line-an IVFluid (see it? Na Cl Dextrose, like D5 1/2 NS). Below the line you've got a report on your Pt's kidneys.

Let's put your Pt's lab values in this form:

Na 133 I Cl 100 I Gl 142 (little low on saline-needs electrolytes)

K 5.3 I BUN 40 Cr 1.5 I CO2 22 (kidneys stressed, moderately dehydrated)

The Pt needs saline and fluid; maybe 1/2 NS at 75 to 125/hr. Does he have a good IV site? Has the Dr seen these labs? Is the IV order appropriate? If he's not eating & drinking you need to see that these things are done. If he's taking PO well, move the water pitch off his over-bed table and put juices there.

See how looking at the labs should suggest nursing action?

2. Do a similar 'formatting' of the CBC: (You'll see the Drs doing this in the progress notes, BTW--that's how I learned it)

Again, draw a line but this time put two 'wedges' on either end of it. Like this:

>-----

And put the WBCs in the left wedge and the PLT in the right wedge and the HGB above the line in the middle, and the HCT below it. (For our purposes, we don't need to know the 'differential' of the WBCs. For general information--its basically an set of percentages (so it should add up to 100) of how young or old the WBCs are. This indicates how hard the body is working churning out WhiteBloodCells.)

So this is what we get for your Pt:

9,8

15.5>------------

28.9

So your guy has a slight elevation of his WBCs but as NeneRN said, you're not surprised by this cause his diagnosis is of an infection. Infact, for a Pt with pneumonia--that's kind of low WBCs. So maybe his infection is low level, or somewhat chronic. You'd relate this to other things you see--is his temp WNL? What's his heart rate? What's his O2 sat? Does he have a productive cough? What do his lungs SOUND like? Etc, etc.

Then with this effective grasp of the data, you can plan Nursing Care. You want to make sure that his mild anemia does not get worse (probably he'd get a unit of blood if his Coronary Artery Disease is bad and his HGB went below 9.0). You want O2 Sats as high as possible because the fewer-than-normal RBCs have to carry their maximum amount of Oxygen to his heart.

So the labs play a part in making a science-based plan of care for your Pt, IF YOU CAN USE IT. And now you CAN!!! WAY TO GO!!!!

Yer ol'

Papaw John

Wonderful explanation, PapawJohn! I plan to use this with my students :)

thanks Papa John....(there's a pizza shop around here with that name..my fav!) but i will try to absorb what you've written :) and you are rite..i am "baby nurse" hahaha

im using this! thx!