Nursing actions for lab values- HELP!!!!

blondy2061h, MSN, RN · Nov 17, 2009

Am I the only one thinking those labs aren't that abnormal? The glucose would only be elevated at all if fasting and the hgb certainly isn't concerning (provided the patient is female). The BUN is the only thing I even find slightly concerning. Crit is mostly consistent with the hgb and the mildly decreased RBC suggests a mild likely iron deficiency anemia.

Trauma Columnist · Nov 17, 2009

Let me move this to the nursing assistance forum so that you can discuss your questions further.

Good luck.

ldalzell · Nov 17, 2009

That could be why the nurse did nothing. I believe the increased BUN is related CHF and dehydration and the CBC counts related to slight anemia. No nursing actions needed regarding these lab values except to continue to monitor.

Does this Nursing Dx sound okay?

Deficient Fluid Volume r/t fluid shifts AEB pitting edema in bilateral ankles and feet, weakness et pt. stating "I came in because my feet were swollen".

rn undisclosed name · Nov 17, 2009

Am I the only one thinking those labs aren't that abnormal? The glucose would only be elevated at all if fasting and the hgb certainly isn't concerning (provided the patient is female). The BUN is the only thing I even find slightly concerning. Crit is mostly consistent with the hgb and the mildly decreased RBC suggests a mild likely iron deficiency anemia.

I thought the same thing. Maybe cause we both do oncology. Yep, I'm pretty happy when I see an H/H like that. And that glucose not bad at all especially if they're getting decadron which is frequently!

blondy2061h, MSN, RN · Nov 17, 2009

I thought the same thing. Maybe cause we both do oncology. Yep, I'm pretty happy when I see an H/H like that. And that glucose not bad at all especially if they're getting decadron which is frequently!

Lol, I RARELY see an H&H half that good.

Daytonite, BSN, RN · Nov 17, 2009

first of all, there are a couple of points you are struggling with here:

the significance of the abnormal lab values
what this patient's nursing diagnoses are

abnormal lab values will become data that contribute to your diagnosing of the nursing problem(s) [nursing diagnoses]. nursing actions (nursing interventions) are the treatments you will order for the symptoms of each nursing problem and that may include an abnormal lab value.

so, you are working up a care plan for a patient admitted with dehydration and a history of chf. your first action is to do a thorough assessment of the patient. a good nursing assessment consists of:

a health history (review of systems)
performing a physical exam
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
reviewing the pathophysiology, signs and symptoms and complications of their medical condition
reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - that includes the labwork

the next thing you do is isolate the abnormal data that you collected during assessment. that abnormal data becomes the defining characteristics (symptoms) of the nursing problems (nursing diagnoses) that the patient has. what you have to do is determine what those are. then, you begin to develop your nursing interventions.

there should have been physical signs of the dehydration (i know because i just spent 5 days in the hospital for this) and it was because i was having problems with adls that sent me to the er. thirst, oliguria, dark concentrated urine, dry mouth, weak pulse, poor skin turgor and tenting, weakness, a little bit of muddled thinking, elevated bun? so, what was going on with this patient? what's the story behind the dehydration?

a good lab manual such as mosby's diagnostic and laboratory test reference or davis's comprehensive handbook of laboratory and diagnostic tests with nursing implications is going to give you some of this information. there are some online sites that might have it:

medicine net procedures & tests a to z index http://www.medicinenet.com/procedures_and_tests/article.htm
web md index list of tests http://www.webmd.com/a_to_z_guide/medical_tests.htm
lab tests online http://www.labtestsonline.org/
also see the "tests" link in the a.d.a.m. illustrated health encyclopedia http://adam.about.com/encyclopedia/index.htm

i will give you the nursing implications for the elevated bun which comes from page 1315 of davis's comprehensive handbook of laboratory and diagnostic tests with nursing implications, 2nd edition, by anne m. van leeuwen, todd r. kranpitz and lynette smith.

observe venipuncture site for bleeding
monitor i&o for fluid imbalance in renal dysfunction and dehydration
nutritional considerations: an elevated bun can be caused by a high protein diet or dehydration
evaluate test results in relation to the patient's symptoms and other tests performed

from page 857 of mosby's diagnostic and laboratory test reference, 4th edition, by kathleen deska pagana and timothy james pagana, 1999.

be aware that urea is synthesized by the liver and when liver disease is present it will affect the bun value
bun should be interpreted in conjunction with the creatinine

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deficient fluid volume r/t fluid shifts aeb pitting edema in bilateral ankles and feet, weakness et pt. stating "i came in because my feet were swollen"

deficient fluid volume is dehydration. you cannot justify having pitting edema in bilateral ankles and feet and pt. stating "i came in because my feet were swollen" as being evidence of fluid loss or not taking in enough fluid and blaming it on fluid shifts. edema is not a defining characteristic of this diagnosis. it's a cardiovascular problem (decreased cardiac output) and most likely related to the chf. did you listen to the lung sounds?
look for other symptoms of dehydration in the patient (i listed them above). along with weakness there should have been difficulty moving, lethargy, concentrated urine and they pretty much felt like crap. the electrolytes should have been whacked as well.
are you sure there is no underlying liver or renal problem here as well?

ldalzell · Nov 17, 2009

Thank you daytonite. I reallly appreciate you helping me. I know the questions may have sounded stupid but then again I am still learning and you helped me learn how to reference Mosby's Diagnostic and Laboratory Test Reference correctly. Thank you!!!