Laboratory Values – Teaching Clinical Reasoning



hello nurse Jim here whenever I teach about lab values whenever I teach about diagnostic data related to laboratory values a lot of questions come up as in how much to 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 let's face it our time is limited we can't memorize everything under the Sun so when I'm teaching about labs I have to I have to make sure that I'm asking so what so what that you know what a low potassium level is you see a two point eight you know that that's hypokalemia so what so what that you know when an alt ast is elevated there's liver issues whether there's damage failure etc there's there's cirrhosis whatever is going on so what what do you do with that information when when we're teaching nursing we're 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 clause some of the obvious reasons are we want to determine the progress of a disease the status how's 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 we're going to 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 acceptable level and stay there and when the BU in a tree at me particularly the creatinine starts to move we get anxious that the graph might be rejected that the new kidney might not be doing what we're meeting it to do the body may not be happy with this new kidney so what what are you going to do about the elevated creatinine what other information do you need to collect about that elevated that elevated creatinine maybe we want to look at hydration status and and develop a terrible and 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 I'm running normal saline with 28 K at 125 an hour and their potassium level has gone up from 4 to 4.5 in the past two shifts something might not be right there 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 I'm values do you focus on because sky's the limit we know how thick 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 what's on NCLEX or what's reported to be important when it comes to ink Lex if you go to ncsbn org that's WWF ESPN org National Council under reduction of risk potential and this is in the detailed test plan for RN or for PN you can go in and look at it here for yourself it's all there for free they give a list of labs they don't give the values okay they give a list of the labs that are related to reduction of risk potential there's there's the client needs area areas and one of them is reduction of risk potential and they put lab values underneath reduction of risk potential here are some of the lab values I'm 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 it's not that if it's not there it won't be on NCLEX that's not the point the point is these are important these are labs that are often encountered by new nurses in quick tests what does the new nurse do most work what is most important for the new nurse at work and so when NCLEX tries to focus that's how their that's how their thinking so if you're wondering you know what lab values should be emphasized what should I focus on this is 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 I've 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 they've identified that hematocrit is low nursing students cannot stop at the fact that they've identified that the WBC's are high they have to do something about it so when I'm setting up a learning activity it's never to see do they remember the values of a particular lab but what do they do with that now you'll notice here that I put assessment in blue an implementation in green okay I encourage students to pick a pattern i encourage schools to pick a pattern use those same colors throughout the entire curriculum if you're a nursing student use the same two highlighters green and blue through the entire curriculum when you open up your lab book and you look up bilirubin look at the assessment data highlighted in blue look at these nursing intervention data highlighted in green then when you're in maternal child and you're looking at care for the newborn you're 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 what the nurse needs to say is assessment and implement that's how that's how we address so what as nurses let's 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 what's probably happening here we're probably dealing with fluid volume deficit or 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 emetic rat values 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 trigger to see if there's tenting look at the oral mucosa see if they're gingiva is dry okay now that's the assessment piece implementation come up with a plan for hydration Oh we'll read and get them a water picture 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 send 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 they're on aspiration precautions and they can only take thick and liquids and oh by the way they hate it and now you've got to do something different now you've got to go a different direction you've got to create a care plan here for this patient that's 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 there's a safety component involved now these are some little acronyms that help me remember KPT is used to monitor monitor patients who are receiving heparin PG T so that H from heparin has two little pole here and each pole points towards a T so PTT for heparin and cool it in okay we need to watch the pt/inr if they're all in coumadin we need to make sure that there are our therapeutic if you don't 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 what so what do I do with that information I see on a laboratory report of PTT is high I see on a on a home med list the patient's 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 they're 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 don't do it you're on coumadin right let your let your provider talk you through that so assessment and implementation well I hope you've 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 go with two colors and use them across the entire program thank you so much for your time I'm nurse Kim please stay in touch bye for now

16 comments

  1. sometimes it feels like there are just people who are nurse educators who shouldn't be in the profession because I got more learning strategy out of this one video than the 3 semesters under my belt in my program…

  2. Really enjoyed this video. Can you please post more for nursing students who are starving for wisdom like this??

  3. I like the highlighter idea! I am a nursing student and as you know…we have a ton of books and that is a great way to organize our notes! Great video!

  4. Oh my goodness, this is a wonderful video. I am a 2nd semester nursing student and this helps sooooo much!

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