Labs, when do I have to call the MD?

[dreamingkim]

]I have been working as a nurse in LTC for about a year, but a few months ago I went to assisted living at the same facility. I am ok at interpreting common labs and usually know when I need to call vs fax, I always call my PT/INR values. But when I get a lab back that is more complicated I am not sure. Now that I am by myself in assisted living, I don't have another nurse to ask, I worry that I am missing something when I get say a UA showing hyaline casts. I hated labs in school, even using reference ranges now, doesn't seem to help. Anyone know what to do to help or remember? Thanks.

[pippylockstocking]

Well one thing to keep in mind is how are these abnormal labs affecting the patient? If the patient is asymptomatic then sometimes you can just fax. If the patient is symptomatic then that will affect your decision on calling.

The big things are the electrolytes. Hypo/hypernatremia, Hypo/Hyperkalemia are major things to call about. Hypo/hypermagnesemia and hypo/hypercalcemia are sometimes important too.

Another major concern is RBC's, H&H, Platelets, WBC's...

If those are elevated or decreased... How is the patient doing?

SOB? Febrile? Weak?

If so then you are definately going to call.

But keeping in mind how have the patients labs been running? Is this an acute change? Or has this change been going on for sometime and the patient tolerates it?

And how much out of the normal range are they?

What meds are they on that may cause the change? What in their PMH may be causing these abnormal labs?

For instance, Na levels of 129 is much worse than Na level of 134. Patient is on lasix and has a K of 3.1 for example.

I work in a hospital setting where MD's make their rounds atleast once a day or some times more often, so things may be a little different than in LTC.

[pippylockstocking]

One last thing... a few Hyaline casts are normal... Now if you get a UA back that is showing moderate to many bacteria, the patient has a fever, and a elevated WBC, and mental changes... You got a UTI going on, so you need to call ASAP. Does that make sense?

With labs it helps to know what will be affected and what are the potential dangers it can cause? Know what I mean?

Here's another example... Is the patient on aspirin or plavix and has a very low platelet count? That's a side effect of being on blood thinners, so it's something you may be calling about to get the meds changed.

[ShaBBy23]

since i too have a hard time remembering my labs, i walk around with a pocket version of my lab values. i have a complete listing of all labs from a-z and their ranges and abnormal numbers and signs/symptoms of the implications of low or high values.

you can find these mini pocket versions at any barnes & nobles.

[casi, ASN, RN]

the mini book is LabNotes. It's fantastic

[Scarlette Wings]

pippy that was a fantastic and helpful answer and i promise to come see you when i have a question. you were informative, practical, and really gave a lot of thought on your answer, not everyone will do that. kudo's to you and have you ever thought of doing eduation? you are a natural!

[pippylockstocking]

awww well hello there Cheyfire... that is where I would eventually like to go but everything in education requires a Master's. I am not even finished my BSN yet. But thank you so much for your kind words.

[CoffeeRTC, BSN, RN]

Try and find out what the doc perfers. Some just want us to fax the labs to them during business hours and will review them and get back before the end of the day. (I always make sure I call the office too)

If it is a critical level, I always call that to the doc.

It helps to look at the last labs that were done to see if there is a trend too. Most docs will want to know this also.

Make sure you are looking at the resident and what the s/s they might have or what you might expect.