New Nurse needs help interpreting labs, please

[nycNurse2b]

When I was in nursing school my profs always focused on us memorizing lab values. Which I always thought was silly because all lab reports list the normal range. Anyway, It would have been helpful if they spent more time on helping us interpreting the lab values.

So in my new role as Charge nurse in LTC the Supv always drops off the labs to me at the start of shift. It is then up to me to interpret them and figure out what can wait, what needs to be addressed ASAP. ANd I struggle with that.

Anyone know of a resource (book, website) that focuses on this in simple terms?

i.e. BUN is elevated so you should push fluids and check the creatiine. That sort of thing.

THANKS SO MUCH IN ADVANCE!!!!

[sweet tooth]

"Laboratory and Diagnostic Tests w/Nursing Implications" by Kee

Honestly, in your position, you should be able to glance at labs and know what's next. Educate yourself quickly.

[classicdame, MSN, EdD]

lab values alone are not sufficient to make a decision. You have to include diagnosis and current clinical assessment, any procedures planned, current meds---- but I suppose you are looking for alert values and drastic changes since last lab. You need a reference. Does your facility use Micromedex?

[Biffbradford]

Also, compare the current to prior labs. Trending up? Trending down? Quick jump? Holy ****! In all honesty, that all comes with time and repetition. You'll get it.

[Guest27531]

Your example of BUN caught my attention because certain patients with CHF who are being appropriately treated aggressively for fluid overload will be expected to have an elevated BUN and and pushing fluids is not the correct action.

You should tread carefully on action you plan to take because of your "interpretations". In a LTC facility, you will likely have very slow turnover of patients so you should concentrate on getting to know the individuals and speak to the doctor for each abnormal that you think should be treated. It may irritate the doctors at first but don't hesitate to tell them that once you come to know each patient, you will not be calling as frequently.

Focus on the critical labs first, such as potassium. If that is too high or too low it can cause lethal arrhythmias. This is one of the only labs I can think of that would cause me to take independent action (if allowed) and I would send a follow-up lab to see if it is real or whether a very high potassium is related to sitting around on the counter all day. A rising creatinine is also an indication that physician evaluation is required. Most abnormal labs do not require independent nursing intervention but certain abnormal labs or trends should be mentioned to the health care provider responsible to diagnose and treat the patient.

[nycNurse2b]

In all honesty, that all comes with time and repetition. You'll get it.

Thanks - that's what the experienced nurses tell me. I appreciate your help!

[Esme12, ASN, BSN, RN]

There are a ton of web sites.

This one is called the ultimate clinicians guide......http://www.globalrph.com/labs.htm

You might want to get an IPhone or Ipad so you can have references at your finger tips......someone mentioned Micromedex. I have used this site. It is awesome!!!!! some facilities actually purchase it for their facility. I would guess a LTC would not but you can purchase a personal version and it's worth every dime. I have no personal interest in this company but it's an awesome product!!!

http://www.micromedex.com/

Congrats on graduationg and your first job!!!!!!! Good luck!

[nycNurse2b]

There are a ton of web sites.

This one is called the ultimate clinicians guide......http://www.globalrph.com/labs.htm

You might want to get an IPhone or Ipad so you can have references at your finger tips......someone mentioned Micromedex. I have used this site. It is awesome!!!!! some facilities actually purchase it for their facility. I would guess a LTC would not but you can purchase a personal version and it's worth every dime. I have no personal interest in this company but it's an awesome product!!!

http://www.micromedex.com/

Congrats on graduationg and your first job!!!!!!! Good luck!

THANKS!

[nycNurse2b]

NY LAdy, thank you for your detailed response, it is appreciated. I apologize that I didnt make myself clear, though. No worries - - I am not to take action on my own. I just wanted to get a better understanding of the labs as they come to me first. I have the MD or NP review them when they get in, but that might not be for several hours. In the meantime, if something is critical, I would have to call one of them. I also like to know, for my own benefit and learning, what every lab means. Ultimately its the MD or NP who really needs to interpret and take action but I am not the type to just throw them in the folder for the MDs review (I actually trained with a nurse who did this - - when I asked if she wouldnt mind taking a minute to go over them with me she said she doesnt really know what they mean - - that's the doctor's job!)

Thanks again to you, and the others, who took the time to respond.

[Forever Sunshine, ASN, RN]

You basically learn lab values as you go and if you feel the need to let the doctor know of a lab value that was low or elevated and can't wait until the morning to start treatment.. don't be afraid to call.

[Sand_Dollar, BSN]

My program has a class just on lab interpretation. The book we use is "Mosby's Manual of Diagnostic and Laboratory Tests". It has everything from blood studies, fluid analysis, stool tests, urine studies, plus many more. It gives the normal findings, critical values, indications, test explanations as well as things that may interfere with the results, the procedure and patient care as well as test result interpretation. For example, if you have a increased Serum Creatinine the person may have: diseases affecting renal function, rhabdomyolysis, acromegaly or gigantism. With decreased levels they may have debilitation or decreased muscle mass (ie. Myasthenia gravis). Listed beside the test results are often the patho behind the disease, so you know WHY it's up or down.

I find the book extremely useful and thought you might benefit from it as well.

[CapeCodMermaid, RN]

It's not up to you to interpret the results of the labs. It is your responsibility to report ABNORMAL lab values the the NP or MD. Unless you have specific parameters from each doc on how abnormal something needs to be, you're better off reporting any abnormal.

Does you lab call you with values that are critical? If not, they should, and you should make it a priority to call the doc on those.

You'll get to learn what lab values mean.