Published Mar 7, 2012
Cuddleswithpuddles
667 Posts
Hello there,
I would like to know if you guys have a special method for analyzing your patients' lab values.
After you get report, at what point do you go into the computer to dedicate your time to analyzing labs?
Do you have a step-by-step system? Do you hit CBCs first, then electrolytes, then XYZ?
How far back do you go i.e. within the past 24 hrs, throughout the pt's entire stay...?
Are there labs that you feel are very neglected by nurses in general?
Are there books on lab values that you love? I love Pagana and Pagana's guide.
I am a new grad working in a cardiac step down and formulating a system for analyzing my patients' lab values. Your input is greatly appreciated. Thanks!
BelgianRN
190 Posts
Hey,
I'm very happy with the options our PDMS offers us for organizing labs. Basically I can select any period of time and draw different labs in if I want to see the trend over days/hours/weeks even. Other than that we have some presets.
E.G. We have a tab called infections and it shows leukocyte count, CRP, temperature, antibiotic use, cultures taken and days lines are in situ for several days. I find it very handy because basically it gives me a quick glance overview of the infectious status of my patient.
Another predefined set is ST-analysis. It shows the analysis of all ST-segments over the selected period including medications like NTG-drips or patches and cardiac enzymes in the blood.
We also have a renal set which includes In and Out data, all diuretics administered and values for Creatinine, BUN, sodium and potassium.
Generally for myself I go over labs when I see my patient for the first time by myself bedside. So this means I'll do the bedside check up and then I'll enter all computer data. Afterwards since I'm at the computer anyway I'll look at history, admission data, medical follow up notes of the past days and the nursing shift reports for the last 24 - 48 hours and the specific care plan. Then it's generally time for labs. Our labs are organized already under different headings and the tab is organized so that every draw has a separate column so generally I'll see 5 - 10 days of labs in one scren. For me I'll follow this order:
The above list is the schematic playing in my head. It sounds much longer than it takes. If you do this daily on multiple patients it takes less than two minutes. But if you don't work with multi-organ failure patients you could trim the list to include the most common problems in your unit.
I don't think the problem is nurses not paying attention to labs but some fail to incorporate disease status when analyzing labs.
For example. They'll freak out over a new leukocytosis but 24 hours before the patient has been put on corticosteroids. They'll jump at slightly raised troponin I levels but the patient is in acute renal failure which can cause light raises in TnI.
The question is of course is it our task as RN's to have an extensive knowledge about labs and how disease processes interact with these values. I wouldn't dare to formulate an answer to that. But I hate when we have families that are freaking out and are fearing serious infection because the nurse told them the leukocytes were going up in the above situation.
FYI I have a great book on lab values and wonderfully written. So I don't know how good your Dutch is ^^.
Vespertinas
652 Posts
. Basically I can select any period of time and draw different labs in if I want to see the trend over days/hours/weeks even. Other than that we have some presets.E.G. We have a tab called infections ......Another predefined set is ST-analysis. ...We also have a renal set ...
E.G. We have a tab called infections ......
Another predefined set is ST-analysis. ...
We also have a renal set ...
Amazing
Yeah it's pretty neat. The MD in our department does parttime programming of the system and he introduced many features to help us and the MD's out in our work. Only thing he can't seem to get right is the stool alert ^^.
Corey Narry, MSN, RN, NP
8 Articles; 4,452 Posts
When I was a bedside nurse, I approached lab values based on body systems. Whenever I receive report, I jot down the data being reported to me based on body systems as well. After report, I immediately go to a workstation and plug in whatever lab values were reported that day. I only write the current labs but also write the previous day's values (in parenthesis) if they needed to be trended. When I have a lot of time, I even write the abnormals in red. In terms of writing labs, I do the following:
Neuro: ammonia level, CSF cytology, triglyceride level (if on Propofol)
Pulm: ABG and/or VBG
CV: cardiac enzymes
GI/Nutrition: LFT's, amylase, lipase, nutritional labs (fat stain, prealbumin, CRP)
Fluids and Electrolyes/Renal: I write chem panel using this diagram
Na / Cl / BUN
K / CO2/ crea
ICa/Mg/Phos
Heme/ID: I write CBC and coags using this diagram:
.......\ Hgb /
WBC / Hct \ Plt
PT/INR/PTT Fibrinogen
then I look up Microbiology results and also write them.
Endocrine: glucose, thryoid function tests, cortisol
This was how I did it so I don't forget a lab value that could affect my care that day.
brainkandy87
321 Posts
I kind of did the same thing on the floor as I do in the ER, i.e. focused assessment. On the floor, I'd look at everything, but I'd focus on labs specific to their condition first. So if they were on a Heparin gtt, I'd check PTT real quick, ARF -> CMP, etc. The main thing I do first though is look to see if any values are very high or very low. Our lab sheets tell us if a value is critical and will show VH or VL. So if I catch any of those, I'll look back to see the trend.
Tiffanybaybay
40 Posts
Check them every single shift, check all that are ordered. Look them up if you don't know them and if they are out of range, look up the time period you have available to you maybe at least a week... something like that or whenever they were last admitted if they just came to you. If you follow those rules you'll never mess up.
APRN., DNP, RN, APRN, NP
995 Posts
When I was a bedside nurse, I approached lab values based on body systems. Whenever I receive report, I jot down the data being reported to me based on body systems as well. After report, I immediately go to a workstation and plug in whatever lab values were reported that day. I only write the current labs but also write the previous day's values (in parenthesis) if they needed to be trended. When I have a lot of time, I even write the abnormals in red. In terms of writing labs, I do the following:Neuro: ammonia level, CSF cytology, triglyceride level (if on Propofol)Pulm: ABG and/or VBGCV: cardiac enzymes GI/Nutrition: LFT's, amylase, lipase, nutritional labs (fat stain, prealbumin, CRP)Fluids and Electrolyes/Renal: I write chem panel using this diagram Na / Cl / BUN K / CO2/ crea ICa/Mg/PhosHeme/ID: I write CBC and coags using this diagram: .......\ Hgb / WBC / Hct \ Plt PT/INR/PTT Fibrinogen then I look up Microbiology results and also write them.Endocrine: glucose, thryoid function tests, cortisolThis was how I did it so I don't forget a lab value that could affect my care that day.
OH MY GOODNESS!! We're Same-ies! I've always done that too. Works like a charm.
It sure does. It keeps me organized to the point that the goal of not missing anything is doable.
Stevenyzwife
46 Posts
As an Australian ICU nurse I am having a huge study to do when we move to the USA next year because of the different drug names, our metirc system, and blood levels. Can someone please email me a page or information on what the "norm" values are in the USA.
It is another thing I need to learn before the NCLEX exam. Anybody think of what else I need to learn that is diffferent. Which ventilators do you use? I know the Purretn Bennets 2000, Avea's and have only seen a Draeger but never used one.
If you can help me, please pm me and I will give you my email address.
Thanks! :)
For the most part, we also use the metric scale in medicine. The only holdover I can think of is that some places still use Fahrenheit. As for norms, it varies by which standards the facility has adopted but if it's computer based, their particular reference ranges should be easily found in the screen near the value.
wanderlust99
793 Posts
Something nurses neglect in report almost always in my experience is infectious disease status. They may mention an elevated WBC, but antibiotics that the patient are on and why we are using those antibiotics...that's rarely talked about, and it's important in an ICU pt IMO.
All our labs are in the computer, so I don't really have a system, I just look at the numbers, compare them to what they were yesterday.