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I often see this question regarding heart rates, but what about H & H? Have you ever gotten lab results on someone who seems normal and then you get a call about a 5 or 6 hemoglobin?
What was your first intervention?
3 hours ago, Horseshoe said:Have you ever gotten lab results on someone who seems normal and then you get a call about a 5 or 6 hemoglobin?
What was your first intervention?
Interesting subject at this time, for me.
Recently, I was passing meds and Jason Hiney was doing VS and assessments on geriatric psych. Jason noted one elderly female patient had a low BP- something like 94/48. He kept monitoring her and the BP did not change. The patient exhibited no overt symptoms, said she felt fine, but Jason contacted the Hospitalist and got orders for labs. Sure enough, the Hgb was critical at 5.7.
The patient was assessed in ER, found to have a +SOB, was given a transfusion, and shipped to medical.
I asked Jason why he kept on the patient when she exhibited no overt symptoms of distress. He said, "Whenever the DBP is below 50, I keep on them!"
I'm not sure that I would have acted so quickly in consulting the Hospitalist since the patient exhibited no overt s/s of distress, so it's a good thing Jason was on VS/assessments and I was doing meds!
Just as a side note, Jason did get recognition for his prudent nursing care.
15 hours ago, Horseshoe said:I had a pretty "normal"looking patient in for something unrelated to GI, and his H & H came back at 6 and 23. Doctor was there and ordered immediate transfusion and consult for STAT colonoscopy.
I argued for repeat blood work before taking action. Got big pushback from doc. Patient told me that when lab drew "they barely got any blood at all".
Do you think in a patient with normal vitals a result of that significance should be re-run before taking action?
I received a patient with very critical K levels. I was horrified when I received hand over and saw nothing had been done.
I immediately reran the labs. It was 24 hours later with no treatment at all they were text book normal. I was baffled until Pt’s husband a Dr told me they had blown the Vein in the lab draw, not gotten enough blood, hemolized the sample and ran it anyway. So yes. If it’s (my gosh how are you even alive) critical, a stat rerun is a very good idea.
7 hours ago, kp2016 said:I immediately reran the labs. It was 24 hours later with no treatment at all they were text book normal. I was baffled until Pt’s husband a Dr told me they had blown the Vein in the lab draw, not gotten enough blood, hemolized the sample and ran it anyway.
That's what I was getting at but you said it much more cleanly. ?
I've seen sickle cell pts as low as in the 4s. When they are in crisis, it is hard to tell exactly if they are symptomatic as their pain is usually very high and they basically feel like crap anyway.
Some of them have terrible transfusion reactions so we will let them live 6-8.
I am primarily an ortho nurse on post-op unit and we don't transfuse until they are under 8. They do labs daily.
amoLucia
7,736 Posts
And very pale.