Misinterpreted lab values ?

[NanikRN]

I'm doing an NCAP project and would value input.

Each month I'm doing a small bulletin board with a lab value, implications, clinical situations where lab might be important. Not just number ranges but more what does this lab mean for the patient. The target audience is for both experienced and newly graduated nurses.

So let me hear from you-- most important labs for all nurses to know? What drives you crazy when someone doesn't get the implications? What lab interpretations mistakes do you see commonly done? Any other ideas?

thanks

[blondy2061h, MSN, RN]

Potassium, potassium, and, oh yeah, potassium. I think a lot of people don't give out of range potassium a their due respect, and some people are very sensitive to them.

Another one is glucose. I hear nurses talking about 150-200 glucose as "not that bad." When you're hitting 200 you're nearly double normal and this is damaging to small blood vessels and putting the patient at risk for infection.

Other labs would include WBC, H/H, creatinine, BUN, magnesium, albumin, sodium, hgb A1c, phosphorus, calcium, and culture results. You could probably do a month on culture results alone with a new billboard each day if you had nothing else to do.

[eatmysoxRN, ASN, RN]

Magnesium.

Who would be likely to have a low magnesium? Telemetry changes. S/sx. Etc.

[dandk1997RN, MSN, RN]

I'm a tele nurse, so my faves? K, Mg, BUN, Cr, INR, WBC...but mostly K and Mg.

Oh, I wanted to add it drives me bonkers when my colleagues don't call the MD/NP/PA about low (but not outside the reference range) Mg and K levels. If you have a Mg of 1.8, that's "normal" by our standards, but I want to get orders to replete that. I want to prevent probs before the dysrhythmias start.

[ChristineN, BSN, RN]

What about how to calculate an ANC?

For BUN/Creat you could include GFR and explain how the declining GFR relates to stages of renal failure

My personal pet peve is a sed rate. I used to work with a bunch of docs that used to draw it on almost everyone, even though it is a fairly generic test.

[Morainey, BSN, RN]

K, Mg, Na, H&H, Bun/Cr, D-dimer, troponins, PT/INR, and BNP are all things I wish school had emphasized a little more. I was definitely weak with lab values when I graduated.

[nurseprnRN, BSN, RN]

Pro time, PTT, and bleeding time -- implications for meds, especially why people get a heparin and warfarin at the same time. I see people get confused over that all the time.

And blood gases! The difference between PaO2 and SpO2, and why 85 is an OK PaO2 but a lousy SpO2. And how hematocrit counts here.

And differentials! Those little numbers after the WBC mean something useful. No reason nurses can't know what it is.

[KBICU]

BNP versus Pro-BNP and how kidney function can affect these numbers! My hospital recently switched to Pro-BNP and I'm not a fan!

Also cardiac enzymes! Differences between grey trops, positives etc

[dirtyhippiegirl, BSN, RN]

Oh, I wanted to add it drives me bonkers when my colleagues don't call the MD/NP/PA about low (but not outside the reference range) Mg and K levels. If you have a Mg of 1.8, that's "normal" by our standards, but I want to get orders to replete that. I want to prevent probs before the dysrhythmias start.

Do you work nights, by any chance?

[dandk1997RN, MSN, RN]

Do you work nights, by any chance?

I do, but I just started nights last week. Until then, I was on evenings. I would get here and my pt would have a low level from the 4am draw that was never addressed even though the attending was around all day. So by the time I get report finished and make sure everyone is breathing, the attending is going home and hard to get in touch with.

[classicdame, MSN, EdD]

I too am bummed by people allowing glucose to be high and K+ to be low. Nurses should know that when insulin removes glucose from the blood it also draws out K+, whether endo or exogenous. Even MD's will say the BS is >300 because the person has an infection. SO WHAT?? Get it down. Had a patient last week who is DNR due to cancer. BS running 300-400 and he felt lousy. Finally talked MD to giving insulin, BS came down and patient said he felt so much better. That alone was reason enough to keep it controlled.