Nursing Interventions for Maintaining Normal Lab Values

[MikesRN06]

Hi guys. I'm in my second semester and am on a Med-Surg rotate. Our clinical instructor is awesome and I find I'm learning great things from her. However, she is somewhat demanding on the paperwork and I have a hard time coming up with interventions to maintain normal lab values. I currently have a pt with CKD, Hx of renal cancer, anemia and a few other things. I have a normal platelet count ( 249 ) but I am at a loss for how to help the pt maintain a normal platelet count. Any ideas?

If you know of any sites that help with this kind of thing, that would be greatly appreciated as well.

Have a great day!

Thanks for any ideas.

Nikki

:)

[classicdame, MSN, EdD]

sometimes the best thing the nurse can do is monitor and then notify MD in a timely manner

Of course, in this (and all cases) safety is an issue. You certainly don't want this patient to bleed

[nurseprnRN, BSN, RN]

There are fairly few purely nursing interventions that would affect lab values. Actually, the only ones I can think of off the top of my head are health teaching for someone with a massive antacid habit who gives himself a metabolic alkalosis, someone with kooky ideas about overhydrating who puts herself at risk for hyponatremia, or somebody who is really fond of lots of enemas, thus screwing up his electrolytes by a sort of autodialysis (I made that term up).

.

Maintaining normal labs is generally the within the purview of the medical plan of care, not a nursing plan of care. Nursing does not prescribe platelet or other blood product infusions, IV fluids and electrolytes, or dialysis specs (among others).

Perhaps you could ask her nicely to clarify what she expects along those lines? Is she talking about, for example, maintaining normal hydration and nutritional status?

[Episteme]

Wait Mike. Back up. What is wrong with your patient? From a nursing, not medical frame of reference. And I mean that in the "Walmart Test" sense of things. Why is this patient in the bed and not walking around Walmart?

Often my students will scratch their heads and say... well, she was "found down" and when they got her to the ER her potassium was over 7. Well OK then. You have a really high potassium and almost every excitable membrane in the body (skeletal muscle, neurons, cardiac muscle, GI system...) all of it goes haywire. Now we can start doing some assessment and make some nursing diagnoses.

Is her anemia so bad that it keeps her from shopping at Walmart? (i.e., would she keel over in the produce section?) OK... now we can do some focused assessment and make a nursing diagnosis for that.

You have to have nursing diagnoses before you can determine your goals/outcomes. (And what is a "goal"? It's your destination, the point of your plan of care...) If you don't have a well articulated diagnosis and a goal, I'm not surprised you're having difficulty coming up with implementation/nursing actions.

Maybe you've done some of that reasoning, but you don't give it to us here... so, it seems like you're hung up on medical diagnoses and trying to balance a nursing care plan on those.

[Esme12, ASN, BSN, RN]

Walmart test...I like that!