Labs that I need to focus and report

jtanga · Jan 16, 2015

I feel sad sometimes because i feel like my coworker been thinking i should know this, that etc

delphine22 · Jan 17, 2015

I do not call the MD with labs unless they are "critical" labs. Those are usually designated on the results (like if it's critically high, it will have two arrows next to the result, instead of just one, or be flagged in red). Also, the lab will call me personally to report critical results, and take down my name. This is then sent as a report to the charge nurse, who will check that I documented that I called the MD with the result and that action was taken.

Check with your hospital's policy on critical lab results, how much time you have to report them, what to do if the MD doesn't call you back in a certain amount of time, where you're supposed to document it, etc. It doesn't make you look ignorant; different places have different policies, and you need to know yours.

Sometimes there are standing policies, like don't call critical troponins if it's not the first one and they're trending down. Or dont' call critical creatinine for a pt already on dialysis. Other times you need a specific order from the MD, "dont' call with critical creatinine, etc."

The only other time I call with a lab result is if it's an electrolyte and I need replacement orders.

P.S. Not to be mean, but "I don't have time to check the labs" is absolutely not acceptable. You need to know your labs for your pt, so you know their status and whether they're trending down or up. I find it's helpful to go over labs with the offgoing nurse during report.

Wile E Coyote, ASN, RN · Jan 17, 2015

Are you so new that you still have or very recently had a preceptor? I'd start by asking said preceptor if they are available. Barring that, know that there are varied illness-specific labs (troponin for cardiac, anion gap and glucose for dka's, etc.) There's also labs that are common to every pt, like lytes or hgb/hct that should be watched. Don't only look for labs that need reported to the docs, you yourself need a firm grasp on the labs for you own management of the pt.

Consider ECCO course if it's offered by your employer ( Essentials of Critical Care Orientation)

RoamFreeRN · Jan 17, 2015

There are some concrete guidelines (like critical values), but this is also something that involves critical thinking & nursing judgement.

Is this a new problem or chronic issue?

Is the abnormality already known & addressed? If addressed, has enough time passed that you'd expect results?

Is it a value that, while may not be critical, may indicate a complication of the pt's problem/condition or a side effect of a new medication? Would a change in this value possibly require a need to re-evaluate a medication dose?

This judgement comes with experience, as well as with a practice that is not just about carrying out tasks but is also about understanding physiology/pathology and â€‹pts response to a diagnosis or condition.

Esme12, ASN, BSN, RN · Jan 17, 2015

Do you have a good brain sheet? Are you a new grad?

Esme12, ASN, BSN, RN · Jan 17, 2015

I feel sad sometimes because i feel like my coworker been thinking i should know this, that etc

I went and looked at your posts...you have been a RN in this country fr some time now and you have worked as a nurse. Your facility should have a policy for the calling of critical labs. The labs you should be looking for are the ones that apply to your patient.

If they are a heart patient you should be concerned with CKMB, troponins and electrolytes. If they are liver failure you should be concerned about the liver panel, H/H, and coags. If they are DKA sugars, electrolytes osmo, and Ph....they labs vary according to disease process and yes...you should know these labs according to disease process.

Ozzy84 · Jan 17, 2015

I went and looked at your posts...you have been a RN in this country fr some time now and you have worked as a nurse. Your facility should have a policy for the calling of critical labs. The labs you should be looking for are the ones that apply to your patient.
If they are a heart patient you should be concerned with CKMB, troponins and electrolytes. If they are liver failure you should be concerned about the liver panel, H/H, and coags. If they are DKA sugars, electrolytes osmo, and Ph....they labs vary according to disease process and yes...you should know these labs according to disease process.

Definitely agree. Depends of patient conditions and diagnosis. As earlier has told that if pt ckd than you don't need to call Md for elevated craeatin. I mean you should also observe your patient if K low and how ecg shows?

SierraBravo · Jan 17, 2015

Sometimes its very overwhelming and I don't have time to check the labs.. Too much info and I feel I have less time.

Others have given you some great advice. Here's the tough love part of it... You need to find the time to keep up on labs and, equally importantly, know what they mean and how/why they relate to your patient. If you draw an ABG from an ART line, it needs to be on your running tally of things to do to check periodically for the results (actually that ABG is going to come back quick since ICU's typically have their own RT's which will run the ABG right away). You may potentially see the results before the provider does, so you can let them know if there is something that needs to be done. If this isn't something that you can do, then perhaps the ICU isn't the right place for you right now.

Editorial Team / Admin · Jan 17, 2015

Sometimes its very overwhelming and I don't have time to check the labs.. Too much info and I feel I have less time.

You need to find the time to keep up on labs and, equally importantly, know what they mean and how/why they relate to your patient.

I agree with sslamster- knowing your lab values and what they mean is crucial to patient care. Make the time to know your labs- keep a brain sheet on each of your patients that includes what labs were drawn and when. Then you can make a point of checking what the results are. Not checking your patients' labs is going to set yourself up for a bad situation to happen at some point.

Ozzy84 · Jan 17, 2015

You have to keep your license in safe. God forbidden if something happen a patient and you would be face to loose it.

HeartRN13 · Jan 18, 2015

If you're looking for icu labs that tend to be important... If a patient is intubated... ABGs are always important especially knowing when the last ones were drawn and when they are going to be drawn again, correlated with vent settings (and if there were recent vent setting changes). Also important to look at would be CMP, to get an idea of the patients electrolyte status, and their kidney function. As a new icu nurse, I noticed how important urine output and kidney function was in these critically sick patients (because often septic patients have poor urine output) and it can be easily overlooked)! Especially if we are dumping huge volumes of fluid into them and it doesn't seem to be coming out! These are basic and my automatic go-to's. Of course with every situation there are others you want to pay attention to, such as cardiac enzymes, lactic acid, hct and hgb, ammonia levels, etc. You'll learn when calls for what!