Discussion

Lab Values and the purpose for a lab to be done.

Oct 17, 200718 yr

Hi everyone,

I'm in my first semester of my school's ADN program. We started clinicals at a nursing home last week and our first set of paperwork is due this coming Monday. I have all the labs that were done on my patient but the sheet I'm filling out has a place for "purpose of test for this patient". How do I know what to put there? Aren't there possibly many reasons for ordering a CBC? I hope this isn't too elementary of a question but I just don't know where to find this information on my own. I have a Lippincott Manual of Nursing Practice 8th ed. and Taber's Cyclopedic Medical Dictionary as my resource books. Any help will be very much appreciated.

Thanks!

Oct 17, 200718 yr

http://labtestonline.org This site was posted in one of the threads. I found it very useful.

Oct 17, 200718 yr

Expert

If this is a new admit, the CBC is probably obtained to get baseline data. CBC is commonly ordered routinely as part of the admission workup.

Oct 17, 200718 yr

Author

I understand the general idea is to obtain a baseline with everything that you do in the event something needs to be compared. This is a patient that has been in a nursing home for over a year and she's had labs done in the last two months within a month of each other. I was just wondering if there was a way to find out what dx/problems a lab might be for. Ex: Lipid-Cholesterol Profile would be to check on her hyperlipedemia, right?

Thanks again!

Oct 17, 200718 yr

Do you have any info about past medical history or any current symptoms/problems the patient is experiencing?

Oct 17, 200718 yr

Author

Hey. This is the form I have to do and just filled in what I know. The only thing missing on the labs is an ECG.

LABORATORY TESTS

Test Name and Normal Range

Purpose of Test for This Patient

Results

Now vs. Admission

Significance of Results/Changes For this Patient

Nursing Interventions Relating to This Patient

Complete Blood Count

8/17/2007 vs. 7/27/2007

WBC 3.7-10.3 9.6 vs. 8.5

RBC 3.56-4.93 3.73 vs. 4.01

Hemoglobin 11.5-14.6 *11.1 vs. 12.1

Hematocrit 31.8-43.0 33 vs. 36

MCV 81-96 89 vs. 90

MCH 27.1-33.7 29.9 vs. 30.1

MCHC 33.5-35.2 33.7 vs. 33.7

Platelet Count 144-402 210 vs. 208

Red Cell Distribution Width 12.0-16.3 14.8 vs. 15.1

Comprehensive Metabolic Panel

8/17/2007 vs. 7/27/2007

Sodium Serum 137-145 143 vs. 146*

Potassium Serum

3.6-5.0

3.9 vs. 4.1

Chloride Serum

98-107

107 vs. 108*

CO2

22-30

28 vs. 30

Glucose Serum

74-106

97 vs. 113*

BUN

7-17

17 vs. 13

Creatinine Serum

0.7-1.2

0.7 vs. 0.7

Protein Total Serum

6.3-8.2

*6.2 vs. 6.3

Albumin Serum

3.5-5.0

3.2 vs. 3.3*

Calcium Serum

8.4-10.2

8.7 vs. 8.6

AST (SGOT)

14-36

18 vs. 31

Alkaline Phosphatase

38-126

79 vs. 128*

Bilirubin Total

0.2-1.3

0.2 vs. 0.5

LABORATORY TESTS

Test Name and Normal Range

Purpose of Test for This Patient

Results

Now vs. Admission

Significance of Results/Changes For this Patient

Nursing Interventions Relating to This Patient

Comprehensive Metabolic Panel (continued)

ALT (SGPT)

9-52

21 vs.

A/G

1.0-2.2

1.1 vs. 1.1

Osmolality

275-300

2.86 vs. 291

Anion Gap

5-14

8 vs. 8

Estimated GFR

>60

>60 vs. >60

Differential

8/18/2007 vs. 7/28/07

Platelet count

144-402

210 vs. 208

Segs

44-77

56 vs. 54

Lymph

14-56

29 vs. 31

Monocyte

4-14

9 vs. 9

Eosinophil

0.2-9.8

5 vs. 5

Basophil

0.2-2.6

1 vs. 1

Neut. Absolute count

1.5-7.7

5.5 vs. 4.6

Lymph Absolute Count

0.9-3.5

2.8 vs. 2.6

Mono Absolute Count

0.3-1.0

0.8 vs. 0.8

EOS Absolute Count

0.0-0.7

0.4 vs. 0.4

Glucose-Fasting

9/27/2007 vs. 5/27/2007

Normal:

74-106mg/dL

*109 vs. 77

Lipid-Cholesterol Profile

8/17/2007 vs. 7/27/2007

Cholesterol

127 vs. 157

Triglycerides

**310 vs. 385*

Direct HDL

> 35

**27 vs. 32*

LDL

38 vs. 48

Factor

**1.55 vs. 1.59*

It didn't turn out right. It's in a really nice chart but I couldn't figure out how to get that on here. Sorry guys

The patients dx are:

Right CVA

HTN

Diabetes (NIDDM)

RSD (Reflex Sympathetic Dystorphy Syndrome)

Athresclerotic PVD

Obesity

Dyslipedemia

AMS

Anxiety

Depression

Dysphagia

Let me know if I should put her meds on here. Thanks so much for helping me try to understand this!

Oct 17, 200718 yr

Excellent questions. The best way to answer that is to look at all the values that are tested and obviously those are the values they are looking at. For the CBC, the main ones are Hemoglobin (HCT correlates) and WBC's. Platelets of course are important as well in case they are taking any drugs that may reduce plts or affect coagulation. So, when I get a new admission, those are the main ones I look for. HGB would show any anemia, such as internal bleeding or even poor nutrition. WBC's would show an active infection. (a differential is done to show the breakdown of percentage of all the different types of WBC's, this is very helpful in telling if an infection is new or older...if there is a high percent of neutrophils, these are the "baby" WBC's, the infection is most likely recent.) The rest of the values, such as MCV, RDW etc, I personally don't pay much attention to... unless the patient has an ongoing chronic condition that merits watching those values.

Oct 17, 200718 yr

The only thing that screams out at me are the triglycerides, but that is hardly news to anybody, look at how many issues she has related to that....CVA, HTN, PVD...

Is she compliant with her diet and exercise regime and her diabetes control? How about medications? Is she on a statin or other cholesterol lowering drug?

Check out this article: http://www.webmd.com/cholesterol-management/tc/high-triglycerides-cause

This should give you a lot of good nursing interventions.

Oct 17, 200718 yr

Author

I guess my main question is:

What purpose does doing a comprehensive metabolic panel have in relation to this patient? A Fasting Glucose would be to monitor her diabetes, right? I suppose what I really need to do is look up these lab tests and see if there's any information that relates to my patient. Thanks for all the help! If you guys can think of anything else, I'd appreciate it. I think my problem is that we haven't gone over what these labs are ALL about and we haven't be taught how to document yet either, so I just want to make sure I get the right info on my form.

Oct 17, 200718 yr

A CMP looks at how the patient is doing metabolically: it shows the status of the electrolytes, kidney, liver among other things. You really do need to look up and learn what the basic lab tests are testing because it will be part of your nursing assessment forever.

Oct 18, 200718 yr

what's ams?

altered mental status?

my instincts said she's starting to get dehydrated.

what are her meds?

leslie

Oct 18, 200718 yr

Expert

as someone has already told you, look up the individual lab tests on lab tests online (http://www.labtestsonline.org/). most of the information you are looking for will be there. other websites where you can find information about lab tests are:

i would recommend that you purchase a diagnostic and laboratory test reference book for yourself. there are a number of them that are published and you can find a list of them on the barnes & noble or amazon websites. they not only include lab tests, but x-ray and various other tests that are commonly done on patients along with descriptions of them, patient preparation, nursing considerations, why they are done and what the abnormal results mean.

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Lab Values and the purpose for a lab to be done.

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