Your method for analyzing lab values

Specialties CCU

Published

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!

I just was asking that the other day! At this new hospital where I work, everyone reports which IV abx the patient is on. Excuse me for being ignorant but I had to ask why do we share that information in report? I got an "I don't know" in response so maybe you can help.

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Hi everyone,

Thank you so much for the wonderful information! Over the past few days on the floor, I have made a concerted effort to analyze labs and have gotten a firmer idea of my patients' lab values. Proud to say that I have been able to report a few unusual changes the computer does not readily flag and was able to anticipate a few MD orders after seeing trends. Small victories yay :)

I found out that my hospital's computer system also has the ability to sort labs according to organ function. For example, I discovered there was a "renal view" function where I can look at lab values pertinent to the renal system. There's also ones for the liver, cardiac, infection etc. It's super cool, and I don't think I would have ever tinkered around and discovered it if it weren't for you guys!

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I just was asking that the other day! At this new hospital where I work, everyone reports which IV abx the patient is on. Excuse me for being ignorant but I had to ask why do we share that information in report? I got an "I don't know" in response so maybe you can help.

I am sure there is a large degree of "It's just what we do" if that's the usual response you got hehe.

My few stabs in the dark:

- One of the immediate things I thought of were nephrotoxic antibiotics like vancomycin. Even if I am not hanging any on my shift or if it was recently discontinued, it is good information to know in case the patient's urine output suddenly decreases. I can go, aha, that might be why and be able to pass that information along to another doctor who might not have this information at his or her fingertips.

- Knowing what antibiotics the patient is on also helps me organize my day. I don't know about your hospital but our antibiotics seem to be scattered all over the globe. If I know XYZ antibiotic is sent up by pharmacy, I'll try to check the fridge or my patients' cubbies at the beginning of the day instead of when I need to hang it. If I wait that long, I usually have to pester and chase after pharmacy to send it.

- In a few instances, the patient's list of antibiotics gave me a insight into what the doctors were suspecting and trying to treat. In one very unusual lung infection-turned-ARDS case I saw as a student, the doctors were giving all the usual big gun antibiotics and antivirals AND antifungals. In that case, the doctors really were stumped and were just throwing everything at the wall to see what sticks.

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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.

One thing I have noticed is that people do not always take the time to ask why a patient is on isolation. Sometimes people cannot even say what organism(s) are of concern and, if they do know, sometimes they do not know where it came from. Is it MRSA, C. diff, Acinetobacter...? Where did it come from? Was it found in routine MRSA swabs or cultured from a wound? Is the isolation for C. diff due to a current infection or precautions because the patient was admitted with diarrhea and was at high risk?

I can see why this information is not on the top of people's list. In the end, everyone has to follow isolation protocols. But I do want to know what I am protecting myself from.

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My mother in law tells me that you guys work in cc's? I have no idea what that is. We certainly don't use it in Australia.

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Specializes in ICU/PACU.

I did a travel assignment where we would have to present the patient to the whole team & one of the attendings is the one who told me we need to include ID in our hand off reports. I started paying attention to it more and starting realizing what antibiotics treat what organisms, etc.. I just think it's important we get the whole picture. And most of our patients were septic so of course it was the primary reason why they were in the ICU so of course we should have known the source of the sepsis:) but often it was neglected.

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CCs = cubic centimeter.

It is the same as milliliter. A milliliter of water occupies 1 cubic centimeter. 1 cc = 1 mL.

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I am about to graduate from nursing school in May and am praying I get a job at a ICU/CCU or Cardiac ICU in my area. I have been searching for "brains" for a while to see what fits. I know I won't really know what fits me best until I'm actually on the floor, but I have been on these units during clinical rotations. If anyone can share their's, I'd be real appreciative. Thanks :bow:

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