Laboratory Values – Teaching Clinical Reasoning

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Nurse jim here whenever i teach about lab values whenever. I teach about diagnostic data data related to laboratory values. A lot of questions come up as in how much memorize.
How much information to pursue related to each valid lab value. Which lab values do we want to look at do we want to focus on lets face it our time is limited. We cant memorize everything under the sun so when im teaching about labs.
I have to i have to make sure that im asking so what so what that you know what a low potassium level is you see a 28. You know that thats hypokalemia. So what so what did you know when an alt ast is elevated theres liver issues whether theres damage failure.
Etc. Theres theres cirrhosis whatevers going on so what what do you do with that information when when were teaching nursing. Were learning about nursing care.
We have to always ask ourselves so what now when we think about lab values. Why why is this a concern for the nurse. Some of the obvious reasons are we want to determine the progress of a disease.
The status. Hows the client doing are they going in the direction. We would expect how are they responding to treatment.
How are they responding to treatment so for instance on renal transplant. Were gonna watch that be you in and creatinine very closely okay they got a new kidney. We expect we expect it to come down to an accessible level and stay there and when the bu in a tree at name particularly the track news starts to move we get anxious that the graph might be rejected that the new kidney might not be doing what were meeting it to do the body may not be happy with this new kidney.
So what what are you gonna do about the elevated creatinine. What other information do you need to collect about that elevate related to that elevated creatinine maybe we want to look at hydration status. And and develop a terrible camp.
A care plan based on hydration status. Maybe we need to have some type of immediate nursing action related to the lab value that we just observed as in im running normal saline with 28 k. At.
125 an hour and their potassium level has gone up from 4 to 45. In the past two shifts something might not be right there.

a nurse is reviewing laboratory results for a client who is receiving heparin via-0
a nurse is reviewing laboratory results for a client who is receiving heparin via-0

I need to do something about that assessment. Implement is the way to go when we ask the so what questions we need to have assessment and implementation in the back of our mind. Now what what im values do you focus on because skys the limit we know how stick the laboratory value manual can be how do you pick and choose one of the ways that i pick and choose is i look at whats on nclex or whats reported to be important when it comes to nclex if you go to ncsbn org.
Thats wwf espn org. National council under reduction of risk potential and this is in the detailed test plan for rn or for pian you can go in and look at it for yourself. Its all there for free they give a list of labs.
They dont give the values okay they give a list of the labs that are related to reduction of risk potential. Theres theres the client needs area areas in one of them is reduction of risk potential and they took lab values underneath reduction of risk potential triggers. Some of the lab values.
Im sorry labs that they talk about the laboratory assessments that that that are mentioned and listed. There now this is not a comprehensive list and national council makes that clear that there can be other items on that list. Its not that if its not there it wont be on nclex thats not the point.
The point is these are important these are labs. That are often encountered by new nurses and collects tests what does the new nurse do the most at work. What is most important for the new nurse at work.
And so when nclex tries to focus thats how their thats how theyre thinking. So if youre wondering you know. What lab values should be emphasized.
What should i focus on this was a good place to start. This is a good place to start now. When i talk about the so way i talk about assessment.
Okay what information do i need or i see. This lab value. What other information do i need or i have a client in this situation.
What information do i need assessment. What data has to be collected and then after ive collected the assessment data. What am i going to do about it i have to do something about it nursing students cannot stop at the fact that theyve identified the hematocrit is low nursing students cannot stop at the fact that theyve identified that the wbcs are high they have to do something about it so when im setting up a learning activity.
Its never to see do they remember the values of a particular lab. But what do they do with that now youll notice here that i put assessment in blue and implementation in green.

a nurse is reviewing laboratory results for a client who is receiving heparin via-1
a nurse is reviewing laboratory results for a client who is receiving heparin via-1

Okay. I encourage students to take a pattern. I encourage schools to take a pattern use those same colors throughout the entire curriculum.
If youre a nursing student use the same two highlighters green and blue through the entire curriculum. When you open up your lab book and you looked up bilirubin look at the assessment data. Highlighted in blue look at these nursing intervention data.
Highlighted in green then when youre in maternal child. And youre looking at care for the newborn. Youre studying that particular part of the text get out your blue green highlighters make sure that you always think in the mode of assessment and implementation when a nurse asks so what about a high lab value a low value lab value and expected lab value.
What was the nurse needs to say is implementation thats how thats how we address. So what as nurses lets look at a few examples here on our little slide over here to the left. We see the urine specific gravity going up.
We see the hematocrit going up. We see the sodium going up whats probably happening here. Were probably dealing with fluid volume vessels that are dehydration so what so what do you do with that information.
Maybe you remember what a high urine specific gravity number looks like what a high hematocrit value looks. Like what a high sodium level is so what the idea is we might need other assessment ticket. This person might be dehydrated check skin sugar to see if theres tenting look at the oral mucosa.
See if there gingiva is dry okay now thats the assessment piece implementation come up with a plan for hydration. Well read and get them a water pitcher and put it at their bedside ps. There on aspiration precautions and can only have thickened fluids right so we started off with dehydration.
We started off with a urine specific gravity that was high we took them to the restroom and looked in the toilet. And the urine was very dark okay and so what we moved from there into the fact that there are aspiration precautions and they can only take thick and liquids and oh by the way they hate it and now youve got to do something different. Now youve got to go a different direction.
Youve got to create a care plan here for this patient. Thats going to help them meet those challenges remember when i said labs are under reduction of risk potential when we look at lab values. Many times.
Theres a safety component. Involved.

a nurse is reviewing laboratory results for a client who is receiving heparin via-2
a nurse is reviewing laboratory results for a client who is receiving heparin via-2

Now these are some little acronyms that help me. Remember. Ttt is used to monitor monitor.
Patients. Who are receiving. Heparin.
Pg t. So that h. From heparin.
Has two little poles. Here and each pole points toward the t. So ptt for heparin and coumadin okay we need to watch the pt inr.
If theyre on to it and we need to make sure there are therapeutic. If you dont know what i mean you might want to go you might want to go research that a little bit. And so our little acronym here is pills taken regularly pt inr that reminds me of coumadin.
Okay. So much so what do i do with that information. I i see on elaborate elaborate or ii report of pt is high.
I see on a on a home med list the patients on coumadin we need to move into so what mode. We need to look for we need to assess for again assessment are there other issues that might be happening as in risk for bleeding as in theyre about to have a procedure an invasive procedure and then what do we do about it. What do we do about it.
What are the implementations that we need to be concerned about as in sir you need to use an electric razor as insert you may see on tv. Those bayer aspirin commercials. Dont do it youre on coumadin right.
Let your let your provider talk you through that so assessment and implementation well. I hope youve seen the value of so what so what remember get yourself two highlighters. Okay make it a little present to yourself blue for assessment green for implementation or whatever your favorite colors are or your school colors.
But bill with two colors and use them across the entire program thank you so much for your time. Im nurse kim please stay in touch bye for now .

a nurse is reviewing laboratory results for a client who is receiving heparin via-3
a nurse is reviewing laboratory results for a client who is receiving heparin via-3

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