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New Nurse needs help interpreting labs, please

Posted

Specializes in Currently: Certified School Nurse.

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!!!!

"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

Specializes in Hospital Education Coordinator.

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

Specializes in ICU.

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

NYLady

Specializes in CCU, L&D, Home Care, Research, Holistic. Has 30 years experience.

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

Specializes in Currently: Certified School Nurse.

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

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

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

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

Specializes in Currently: Certified School Nurse.

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

Specializes in Currently: Certified School Nurse.

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

Specializes in LTC. Has 7 years experience.

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

Specializes in Critical Care, Clinical Documentation Specialist. Has 5 years experience.

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

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

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.

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.

I agree with this. There is a limit to the amount of interpreting you should be doing. Another thing that is important is to know why the labs were ordered. What diseases does the patient have, what would be the expected values and what is going on with the patient that these particular labs were ordered.

You do need to have an actual conversation with the doc about critical and stat labs, as well as PT/INRs, which is so much fun at 3:00 in the morning. Most abnormal lab results can be called in to the messaging system during the business day if you know that they will be getting those messages and calling you back that same day.

Just keep in mind that if they don't call you back you may have to follow up with an actual conversation with the doc that day. A lab with all normal results also needs to be reported, but you can just leave a message for that.

A positive UA, or an abnormal X-ray or ultra sound needs an actual converation because that's the kind of thing that you will need tx orders for, and the sooner the better.

You will eventaully learn that the doc ordered a certain lab because they want to know a specific type of information about the patient's disease process. Usually if the abnormals are not completely out of range into critical those calls can wait until business hours. It takes practice to figure out what's important.

LTCangel, ADN, BSN, LPN

Specializes in LTC, Float Pool, Ortho, Telemetry. Has 25 years experience.

It's also important to compare current lab values with earlier ones so that you get a feel for the patient's baseline. I learned that not everyone is normal so it's important as someone else said to know what is a really big difference that may need called. Also lab values that have to do with medication such as Dilantin or Lamictal are important because if they are too low or too high then meds need to be adjusted, also PT/INRs for Coumadin levels.