Need help with labs!

evilolive, BSN, RN · Jul 27, 2012

I have been out of the hospital for 20 yrs and I don't even remember having a class about labs. I'm in orientation and was told I need to check patient lab values everyday. Well there are tons of them! Which ones are the most important? I just don't have time to write down every single result. What do you do? Is there a good resource about labs that anyone recommends?

Electrolytes, Mag, Phos, CBC are the ones I see regularly on a telemetry floor. If you use a computerized system it may give your facility's lab value range when results come back, which makes reading them easier. Always know your facility's high/low ranges and you'll be good. It definitely varies from place to place.

FORTHELOVEOF!!!! · Jul 27, 2012

A general lab book would work just fine. The most important labs are the abnormal labs. If the patient is admitted with an abnormal lab you need to keep an eye on the results every time they are drawn. Refresh yourself on the manifestations of altered electrolytes so that you can notice the differences in your patients and act quickly. Doctors interpret the results the majority of the time and the computer will tell you your ranges. Get to know your therapeutic levels of coumadin, heparin, and other common drugs because you will have to act on them first and then call the doc. I'm sure it will all come back to you and you can familiarize yourself with your specific specialties common labs and use a book for the ones you don't see all the time. Good luck!

turnforthenurse, MSN, NP · Jul 27, 2012

Any kind of lab values book should suffice. And if you have an iPhone, I recommend the Lab Values+ 3-in-1...I think it was a couple of bucks in the app store. Good mobile reference.

Pay attention to abnormals...and also pay attention to normal labs that may become abnormal. For example, ALT & AST (liver enzymes) were normal, but now they are elevated. What could be going on? What's their PT/INR and PTT look like? Notify the doc.

I work on a cardiac step-down and we pay most attention to electrolytes, PT/INR, PTT, CBC and renal function. But all labs are important and changes need to be reported to the MD.

jennilynn · Jul 27, 2012

I always check H&H, PT/INR, electrolytes (k+, na) , kidney function. Anything that may be specific to the patient (lft, billi for cirrhosis; ammonia and lft for hepatic encephalopathy; BNP for CHFers; cardiac enzymes for MI; etc)

We have computer based lab results that give us the ranges and hi/lows, so that is helpful, too.

sbostonRN · Jul 27, 2012

It gets easier with practice. For the most part you don't have to know exactly what every lab value means but you do need to know what to assess for when something is abnormal. For example, if your patient's BNP is high (CHF), you want to assess for SOB, O2 sats, edema, JVD. If your PT/INR is critically high, you want to assess for bruising, bleeding, etc before calling the doctor with the values. Also know what it's been trending. If their Hgb and Hct is always a bit low, the doctor is likely aware and may not be concerned (this is common in the elderly).

itsnowornever, BSN, RN · Jul 27, 2012

I'm just a student, but in testing situations, practice questions and on the floor I get their diagnosis, and then look at labs pertaining to that and see if they are normal/abnormal and why...then I look at medications, and find the labs that would be altered due to med and see if they are altered. If there is an altered lab that doesn't fit those two I try to figure out what the cause could be.

Example---pt in the ER had peaked T waves, checked potassium, yup HIGH...fixed the potassium and then looked for the cause, turned out it was a cardiac med he was taking that can cause high potassium in combination with his attempt to eat healthier (meaning foods high in potassium) to decrease his high cholesterol levels. Some education, kayexelate and a note to the floor nurse that was getting him to maybe talk to doc to have his cardiac meds switched.

Nurse ABC · Jul 28, 2012

Ok thank you for all your responses. That helps a lot and makes me feel better! :)