Lab Values
Understanding the ranking of lab values is crucial for prioritizing patient care. Here’s a breakdown of how to categorize lab values based on urgency:
- A (Abnormal) – These values are outside the normal range, but no immediate action is required. You can monitor them without intervention.
- B (Be Concerned) – These values indicate a need for closer monitoring and reassessment, but they are not immediately dangerous. Follow up as necessary.
- C (Critical) – These lab values require prompt attention. You must take action, but you can leave the patient’s bedside if needed to carry out further interventions.
- D (Deadly/Dangerous) – These values are life-threatening and demand immediate intervention. Stay with the patient at all times and act urgently.
| Normal Level | Abnormal Level | |
| Serum Creatinine | 0.6-1.2 | Elevated serum creatinine levels are typically a concern, indicating potential kidney function issues. However, if the question specifies that the patient is scheduled for a procedure involving contrast dye (e.g., in the morning), an increase in creatinine may be expected due to the effects of the dye on the kidneys. |
| INR | 2-3 (on warfarin) | C) INR of 4 or higher – This is a critical value, indicating a high risk of bleeding. Immediate action is required. Hold any anticoagulant medications (if applicable), assess for signs of bleeding, and notify the physician. |
| K+ | 3.5-5.3 | C) Low or High – Abnormal potassium levels, whether too low (hypokalemia) or too high (hyperkalemia), are critical and require intervention. Assess the patient and prepare for possible treatment, such as potassium supplementation for low levels or medications to lower high potassium. D) Potassium 6.0 mEq/L or higher – This is a dangerous level of hyperkalemia. Immediately assess the patient’s cardiac status, prepare to administer interventions (e.g., medications to lower potassium), and notify the physician immediately. |
| 7.35-7.45 | D) pH in the 6’s – A pH level in the 6 range is dangerously low, indicating severe acidosis. This is a life-threatening situation requiring immediate intervention. Assess the patient’s condition, initiate emergency measures, and notify the physician immediately. | |
| BUN | 8-25 | A) Elevated BUN – An abnormal increase in BUN levels often indicates dehydration. Assess the patient for signs of dehydration and consider fluid management as part of the care plan. |
| 12-18 | B) 8-11 g/dL – This range suggests potential issues such as anemia, bleeding, or malnutrition. Further assessment is needed to determine the underlying cause. C) Less than 8 g/dL – This is a critical value indicating significant concern. Assess the patient for active bleeding, prepare for a possible blood transfusion, and notify the physician immediately. | |
| Bicarb | 22-26 | A) |
| CO2 | 35-45 | C) 46-59 mmHg – This indicates elevated CO2 levels. Assess the patient’s respiratory status and encourage pursed-lip breathing to help reduce CO2 levels. D) 60 mmHg or higher – This is a dangerous level, indicating respiratory failure. Immediately assess respirations, prepare for possible intubation and ventilation, call the respiratory therapist (RT), and then notify the physician. |
| 36-54 (= 3X Hgb) | B) Hct 54% or higher – An elevated hematocrit level may indicate dehydration. Assess the patient for signs of dehydration and consider interventions to address fluid balance. | |
| PO2 | 78-100 | C) Low 70s – This indicates a decrease in oxygen levels. Assess the patient’s respiratory status and prepare to administer supplemental oxygen as needed. D) 60s or lower – This is a critical level indicating severe hypoxia. Immediately administer oxygen, assess respirations, and prepare for possible intubation and ventilation. Call the respiratory therapist (RT) and notify the physician. |
| O2 | 93-100 | C) Less than 93% – This indicates inadequate oxygenation. Assess the patient’s respiratory status, raise the head of the bed to improve breathing, and administer supplemental oxygen. In “best” answer scenarios, simply providing oxygen is the priority. |
| BNP | <100 | B) 100 pg/mL or higher – Elevated BNP levels suggest potential heart failure. Assess the patient for signs and symptoms of congestive heart failure (CHF) and monitor closely. |
| Na | 135-145 | B) Abnormal Na with no change in level of consciousness (LOC) – Assess the patient for other symptoms, but no immediate intervention may be necessary if there are no neurological changes. C) Abnormal Na with a change in LOC – This is a critical situation. Assess the patient thoroughly, as changes in sodium levels with altered mental status could indicate a serious condition requiring immediate intervention. |
| Plt | 150K-450K | C) Less than 90,000 – This is a critical value. Assess the patient for signs of bleeding and monitor closely, as there is an increased risk of bleeding. D) Less than 40,000 – This is a dangerous value. Immediate intervention is required due to the high risk of spontaneous bleeding. Notify the physician immediately and prepare for possible transfusion or other interventions. |
| RBC | 4-6m | B) Lower or Higher than Normal – Abnormal RBC levels may indicate various underlying conditions. Low RBC levels (anemia) can suggest bleeding, bone marrow issues, or nutritional deficiencies, while high RBC levels (polycythemia) can be associated with conditions like dehydration or chronic hypoxia. Assess the patient to determine the cause and monitor as needed. |
| WBC | 5K-11K | C) Below Normal Value – A low WBC, ANC (Absolute Neutrophil Count), or CD4 count indicates a compromised immune system. Assess for infection risks and take immediate precautions. -Low CD4 – A low CD4 count (below 200 cells/mm³) indicates progression to AIDS. -Neutropenic Precautions – If WBC or ANC levels are critically low, place the patient on neutropenic precautions to protect them from infection. |
| ANC | 500+ | |
| CD4 | 200+ |
Neutropenic Precautions
When a patient has low neutrophil counts, follow these strict precautions to prevent infection:
- Strict Hand Washing – Always wash hands thoroughly before entering and after leaving the room.
- Shower Twice Daily – Use antimicrobial soap for showers twice a day.
- Avoid Crowds – Limit exposure to groups of people.
- Private Room – Ensure the patient is in a private room to reduce infection risk.
- Limit Staff Entering the Room – Minimize the number of staff members interacting with the patient.
- Limit Visitors to Healthy Adults Only – Restrict visitation to healthy adults with no signs of infection.
- No Fresh Flowers or Potted Plants – Avoid bringing plants into the room as they can harbor bacteria.
- Low-Bacteria Diet – No raw fruits, vegetables, salads, or undercooked meats.
- Fresh Water Only – Do not drink water that has been standing for longer than 15 minutes.
- Frequent Vital Signs – Check vital signs, especially temperature, every 4 hours.
- Daily WBC/ANC Monitoring – Check white blood cell (WBC) and absolute neutrophil count (ANC) levels daily.
- Avoid Indwelling Catheters – Refrain from using indwelling catheters whenever possible.
- No Reusing Cups – Wash cups between uses or use disposable cups.
- Disposable Utensils – Use disposable plates, cups, straws, and utensils (plastic knife, fork, spoon).
- Dedicated Items in the Room – Keep these items exclusively for the patient:
- Stethoscope
- Blood pressure cuff
- Thermometer
- Gloves
- Assess for Infection – Regularly monitor the patient for any signs of infection.
When Something Is Critical
Follow this sequence of actions:
- Hold/Stop the action or medication first.
- Assess the patient’s condition.
- Prepare to administer treatment or perform necessary interventions.
- Call the Doctor to report the critical situation.
Apperture Labs 