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Mark Klimek Lecture Notes
LECTURE 8
Lab Values
High priority lab values
- Abnormal but not a priority (don’t have to do anything about it, you can
- Abnormal and need to be concerned but still nothing to do, just watch them
- High Priority- critical and must do something about it
- Highest priority that you can possibly have with a lab value
ignore it and have the doctor discover it in the morning and there would be no troubles
Creatinine- best indicator of kidney or renal function (SERUM) 0.6-1.2 same (numbers as the lithium range) Level A – have kidney disease but that’s fine, only make a phone call if they had a test the next morning that involved dye
INR-International Normalized Ratio- monitors coumadin therapy, like the pt (variation of the prothrombin time)- normal range is between 2-3, anything 4 and above is a Level C- critical and you need to do something- whenever you get a situation on what you need to do for something, there is a protocol you need to
follow:
1) Always HOLD- if there is something that’s causing a problem stop it, 2) Asses- focused assessment on the area the lab value is telling you there is a problem with 3) Prepare to give- whatever you need- don’t always give just prepare 4) Call whoever is appropriate
Example: HOLD Coumadin, assess for bleeding, prepare to give vitamin K and
call your doctor
Potassium- indicator that something is wrong- 3.5-5.3- a low potassium is a Level C- don’t need to hold anything, assess the heart, prepare to administer potassium, and call the doctor a high potassium level 5.4-5.9 is a Level C-hold off potassium, assess the heart, prepare Kayexalate/D5W/Regular Insulin and call doctor- if the potassium is greater than or equal to 6- it is DEADLY- Do everything you’d do for a level C and call STAT- have a nurse handle every task- cannot leave the bedside of a D but you can for a C- so remember you stay at the bedside and everyone else helps you get 1 / 2
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it done
pH-7.35.7.45- a pH in the 6’s is a LEVEL D- Assess vital signs because as the pH goes down so does your patient- doing vitals to make sure their still alive- cannot
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