New nurse confused about important lab values

[sduRN]

Hi everyone! I am a new nurse, just graduated in May and started working on a Step Down Unit in July. I just got off orientation last week and to say the least.. I'm scared to death! I have worked two days on my own so far but it was the weekend and they gave me a pretty light pt load. I was an LPN for a year before going back to school, and i feel like nurses expect me to know more than I do. However I worked LTC and of course SDU is a completely different world. As an LPN I was basically a med/tx nurse. I never really had to deal with calling doctors and I always had an RN to run to. I am kind of confused about lab values.. I know the values and can tell if something is high or low, but how high or low should something be to call the Dr? K+ is and easy one because its so touchy. But what about others? I know to look at trends, for example, yesterday one of my pt's had a hgb of 9.8 and I didn't call because his values from the previous 3 days were 9.2, 9.5, and 9.5- the Dr was already aware of those ones. Our labs come up on the computer system and they are pink if high or low. While orienting, there would almost always be pink on the screens of each patient and each preceptor seemed to call on different labs so now I'm kind of confused. Any input would be appreciated:)

[diprifan]

Well, Looking at trends helps...

You have to know what is going on with that patient as a whole.

A G.I. bleeder that has a 2.5 drop in hgb from 10.0 to 8.5 is going to warrant an intervention.

The patient with tall peaked T-waves or U-waves present, you might want to know the K+ level and report it to the Dr. with the findings, because there is something wrong.

It is all in context. Just ask questions, if something doesn't seem right in the lab work or you are unsure, ask someone!