Lab Panels – The Basics and What YOU Need to Know

Amber asks, as we're talking about this, um, amber asks, what, uh, what does that include? Does that include the abdominal cavity? So meaning any of that third spacing of that fluid that builds up. So the aside is, will the albumen help? Sometimes it does, sometimes it doesn't. I mean, in theory it should. Um, but the problem is is you're fighting a lot of other um, spaces, right? So in order, the other thing is you have to remember the inside
lasix. Sometimes Lacey's can be a better choice. It depends on how bad their assignees is. Um, lasix can sometimes be a better choice, but you also have to take into consideration things like kidneys and you have to take into consideration like a potassium. So is this patient's potassium already low so that the patient's potassium is already low? We're going to give them lasix, we're going to cause their, their potassium, even a tank even more. So we have two. There are more things that can spare. Naloxone is sometimes okay. Sometimes it might experience sparing. A lactone by itself is not as strong a have and a have a diuretic in terms of pulling fluid off. Sometimes you have to use it synergistically, meaning that you have to use several different medications in order to do that. Um, but for the most part, that's one thing that you want to be considered of like, okay, can we give a diuretic?
Are they already on a diuretic? What is their blood pressure doing? Like it's multifaceted. It's not just like he's got third spacing, we need to do this. He's got a sites, we need to do this. It's very much like you gotta look at the patient holistically. So GFR, GFR is that glow glomerular filtration rate. So who can tell me what a standard, right? So Reed says it's for the kidneys with a GFR. Who can tell me what kind of the standard is or what the rule of thumb is for evaluating a GFR on a patient. It's actually a really simple one when we break it down,
okay,
I had this mannequin, this, this guy right here behind me and he's over 60. Okay. So here's Rachel says every 60 greater or equal to 90. So here's the where I remember the rule of thumb for GFR is that the um, the efficiency or the health of the kidney is equal to a hundred. So meaning that if the GFR is 90, that means that 90% of the kidney is functioning. If we drop it down to 60, 60% of the kidney is functioning. So that is going to be your biggest, your biggest indicator if GFR is 20, it's like some crazy formula. It's like 20 mils per minute per 1.7, two meters squared. A body surface area I think is the actual, um, thing. But with this, the GFR, that's going to be your greatest indicator of kidney. Yes. Like we talked about being an incurrent.
So let's say your bun is bumped and your [inaudible] is okay, but your patient's GFR is 90. What does that tell you about your patient's kidney function? Or what would you maybe suspect is wrong with your patient based on those? Let's say [inaudible] uh, let's just say it's elevated. I'm not going to give you an arbitrary number. Let's just say your bun is slightly elevated, crown is fine, and your GFR is 90. Exactly dehydration. So we can't say that the patient's Bun is elevated because of the kidney. So let's say it'd be on his butt, but the GFR is 60. Well, we suspect at that point.
Exactly. So there's a, there's a problem with the kidneys being able to filter. I'm actually drinking a lot of water today, so I'm harsh, which probably checked my GFR in and a bun. All right, so that's your CMP. So the other thing about CNP is that with that CNP your, it takes a longer to get back. There's more stuff that goes involved that's involved in this panel. So don't expect it to get a quick turnaround time for your patient. If you need things like, Hey, you've got to live her patient with cirrhosis and their jaundice and you need all of these things, sheer CMP and house grade, um, you're going to see this more in clinics. You will see some of these in a hospital. Um, typically what happens is you'll get like, okay, I want to be in p plus LFTs liver function tests. We'll talk about that in a minute. What's your, basically just these, but that gives you, that allows the lab to be a little bit more efficient. But CNP, you're gonna this is the one that I go to my doctor every year and they do a full comprehensive panel. This is a smooth one. And the next one,
so I said earlier, additional lights are, so mag and phos aren't included. They're not included in the CNP or the BNP. So it's usually I need an order for c and p c a, it's usually like CMP, CBC, um, uh, mag and Phos, right? So they'll say they'll ask for those. Typically, the best thing you can do in any of these situations is to contact your facility, contact the lad, hey, what's included in all these panels? A lot of them will have it. So just know that anytime you have a patient who needs mat, extra mag or a extra phos, magnesium or phosphorus, phosphates, uh, just make sure it's not included in your regular panels. And see if you've been trending in before. So let's go on to the next one. CVC. CVC stands for complete blood count. Give me some indications as to why we would need a CBC on a patient. Just start throwing them up there. Infection, infection, infection. Yep. Yep. Anything else?
Anemia. There it is. Cancer, blood transfusion. Perfect. Those are all good answers. Those are all great answers. So with the CBC, Hey, we're looking for infection and the, there's the four that I usually think of, infection, inflammation, leukemia and anemia. I, and then the emia is right. So those are generally speaking. Um, those are just kind of the way that I remember if I have patient and I'm suspicious of any one, one of those four things, I'm, I'm know always going to be doing a CBC. So CBC and, um, I do a separate tutoring session on cvcs where we break those down and we go quickly into the different, like we go in depth into the differentials and we give you some, some examples. Um, but this is, uh, this is the real quick way to remember it. So you've got white blood cells and with differential, so you're going to be looking when, uh, amber asks when, um, I can probably set one up for maybe late next week, so maybe next Friday.
Um, something like that. I know that the labs have been a huge request, so I want to make sure that we're getting those done cause I love doing labs. Um, so I'll make sure that, I'll try to put that up for a next, I think next Friday. Um, perfect. Well I'm doing it. I think I'm doing cardiac labs today. I have to double check. Uh, but we'll go into those. But it takes practice. I will say this, that, um, and I always talk about my previous experience as a vet tech before it was a nurse. It gave me 800 of experience dealing with these kinds of things. Um, because I did that for 10 years before. And so you get to the point after 10 years, you get used to working with things a certain way. So what we try to do is I'm going to give you some resources here at the end.
Uh, just some cheat sheets and quick facts to, to have with you that go over these things. Um, CBC, but basically you're looking at white cells. So this is going to be your infection and the inflammation. Um, and then you've got your red blood cells and then um, your hemoglobin and hematocrit. These all play together because hemoglobin, um, is going to be the ability to carry oxygen. So, uh, it's not, it's not quick, it's not totally tied to it, but that's going to be the one that says, OK, um, that's going to tell me like oxy kind of give me an idea of oxygen carrying capacity of the red blood cells. Um, and then, um, hematocrit. What's the difference between Hemoglobin and Hematocrit? Mainly hematocrit. Just give me some answers as to what you guys think. Shape. Nope, not quite shape.
Okay.
DB Ass oxygen capacity. Nope. That's gotta be your hemoglobin clotting note. So real quick, hematocrit is a percentage. Is it percentage of total blood volume to the, yeah. Carries. It's a percentage or a curious as the hemoglobin. So it's actually, they can matter. Crit that is a percentage. Um, hemoglobin is a, a, it's a measuring a measurement of a specific protein. Yeah, it's, you've got it backwards. Um, but the Hermatocrit is a percentage of total volume blood volume. So if you look just, it's, it's an easy way to sit there and say, okay, I know that it's normally total blood volume as a hundred. The um, red blood cells account normally for about 45%. So I know if I've got, uh, American of 20, I know that it's low or if I've got an American to 70, I know it's high. It's just a quick frame of reference, which is what hermatocrit means.
Um, and what you're actually measuring is red blood cells. So sometimes, for instance, a sickle cell anemia, right? So in sickle cell, the red blood cells are actually changed. Um, it can, yes. So if you have a patient, um, so Stephanie asks, does that indicate hydration levels? Yeah. So you can, in your CVC, you can look at your hermatocrit. So remember that water is in my draw a test to one second. I actually here, he's my mom. Okay. Can you all see this? This isn't a bottle of water. Okay, cool. So like, let's say this is your blood volume, remember, and about 45, 55% of it. So like to right here is about, uh, your blood plasma. And then this other 45% is about, um, is your red blood cells. Now remember that water resides in the blood plasma. These are all packed red cells is what that is. So as I spin it down, it gives you an answer. So if a patient had was dehydrated, would you anticipate that your plasma, um, that this would be high, a high percentage, would it be 55% higher than 55% or lower than 55%?
So if it says hi, Phoebe says low room, it says lower. Yeah. So remember, because, um, because the water and the water resides in here, if you have less water because you're dehydrated, it's going to get smaller. So your applied yet, so your plasma is going [inaudible] the low. So your red blood cells, remember, it's just a percentage. It doesn't tell you the actual count, which is what red blood cells the RBC does. Yeah. So it's a total volume. Um, there's really the lesson that explains all this. Um, but this is again, this is why we do these tutoring sessions so that we can help you. You're like, oh, I think it's this, but we want to make sure that you guys really, really get it. Um, so when we're looking at, so let's say a patient that has sickle cell, the is going to count or whatever analyzer is actually going to count the red blood cells, but it actually changes the fraction, the amount of hemoglobin that they can carry and also can modify hematocrit. So when we all, when we look at the CBC and we want to see a patient's like true in the Amea levels, we look at the red blood cells, hemoglobin, Informatica. Now PLT stands for what? This one is TV, platelets, wait, let's play this. Play this. Yeah. So platelets, who can tell me what number, like what value I should be looking at for a minimum for a patient that has, uh, some sort of, uh, in Christmas,
amber. Uh, Yep,
that's right. Amber asks, increase red blood cells, decreased plasma, yet dehydration. That's what it's going to be. That's great. It says 150,000, um, anybody else care to venture a guess on like the absolute absolute bottom number that we need to say? Okay. Anything less than this, we need to consider some sort of clouding issue.
The answer is a hundred. So it's like a hundred to four 50. I'm going to put a huge caveat in this because there's been a little bit of um, talking about, um, Reed, I'll answer your question in one second. There's been a little bit of a discussion about what's normal. Your heart stops should be, what is my facility consider my lowest platelet volume? And if I look at that platelet value, if it's less than that, I need to know what that means. Right? So for the general rule of thumb is 100,000, but pay attention in your facility, cause your facility could say thrombocytopenia is actually 150,000. Anything less than 150,000, your policy is to do x, Y, and z. So it's important to always find out what the values are for terms of like in clicks testing and you're looking at like a a hundred thousand is your low.
So anything less than a hundred thousand, we should consider some sort of bleeding issue. Now read at a rate ask what's the difference between platelet and PTT? PTT stands for a partial from a, from a plast in time. It's actually measurement of time. I would have to, um, so whereas platelets are the actual count of thrombocytes, the actual amount of like platelet cells per given per, I think it's either milliliter or deciliter. Um, but uh, that's the difference between the two plate, uh, PTT. You're gonna look at your, this is going to be with like Heparin therapy, whereas platelets play a little bit. So like Plavix isn't an pot, uh, is a medication that will actually impact platelets, but it won't actually impact, uh, your PTT. So your, so your PTT,
um,
your PT, your PT, PTT and INR play into things like Heparin and Warfarin, whereas platelets are going to be influenced by things like Plavix.
Yeah, it's really confusing. I know I get it. Oh, and as a matter of fact, right after this session and like six minutes, I want to wrap this up real quick because I know that I want you guys to jump on to, if you're, if you're here, I want you to stay on, go back to that tutoring dashboard. And what's going to happen is Nicole is gonna do an entire um, uh, tutoring session on, um, anticoagulants. So she'll be able to answer some of these. So let's hop through the rest of this so I can answer whatever questions you have that way you guys can get on there. And she, and I know because she's going to be dealing with a lot more of the pharmacology. And I know you guys have some questions so we can get that all together. Oh, let me go back real quick. I just want to show you this instigate, oops. Break the TV. MCH MCHC and RDW mean corpuscular hemoglobin mean corpuscular hemoglobin concentration and red, a red cell distribution with makes very impacts your practice very, very little. Um, this plays more in line with a hematologist or oncologist, like they pay more attention to those levels than we do as nurses because the things that we're going to do are, um,
yeah,
have, have greater value for the other big four. So white cells, red cells, platelets and hemoglobin, hematocrit h and H. Okay.
[inaudible]
next one. Let's move on. Okay. Liver function panel. This is different than liver function tests. Liver function panel has your LFTs in here, one, two, three, but it also pays attention to your ability to then proteins and some providers will also request, and this is, this isn't included in your liver, uh, your liver function panel, but it's something I want you to consider. So if, let's say you have a partial hepatectomy come back, they go, they have like a, it's um, liver removal or partial like a liver lobe removal. Let's say they have liver cancer. You're gonna wanna check co-ax on that patient because your liver impacts your co-ax. Okay. So that's the only important thing that you need to know is that the liver function panel is different than liver function test. Liver function panel is an entire panel plus proteins because of the impacts proteins.
It also impacts your co-ax. Don't also, don't be surprised if you run a CBC on that too. Let's see, what's the next one? Renal panel. We talked about this earlier, Bili and creatine a, your analysis, we're obviously going to get lights and then the GFR. Now one thing about a year analysis is you may also get like a serum creatinine and the urine Creatinine, which requires a 24 hour collection, 24 hour urine collection. So I want you to real quick to tell me the chat was a one the most important thing that you need to know about a urine collection. The 24 hour.
There it is. Toss the first one. Yes, it needs to be on ice, but more importantly you have to toss the first one because it's basically, hey, we're going to get a urine collection on you for the next 24 hours. I'm going to have you go ahead and just use a urinal or go to the bathroom, whatever and say from this point on, for the next 24 hours, I need to collect every single sample every time you void or um, I gotta have it in this big bucket. Okay. So that's you always gotta toss the first one. That's the most important one on one. Let's move on. See what else we got. Lipid panel. So Lipid panel, you're going to look at triglycerides, cholesterol and HDL and LDL. Okay. Who could tell me the difference between or let me, let me rephrase this. Um, HTL do we want it high or do we want it low?
Yup. High, high, high HDL. We want it high. A High D, high density Lipoprotein, LDL. We want it higher. Low. We want it low. We want that thing. Low. HDL actually helps in uh, moving LDL out of the body during that. It's a very long convoluted process, but you always want your HDL higher and your LDL lower always paid attention to maybe facility your lab requirements. Um, I can give you numbers. They are general guidelines. If things about the thing about lipid panels is this more is more of a risk panel. So I want to see how patients are responding to statens. I want to see how patients, how much of a patient is at risk for um, non, uh, nonalcoholic fatty liver disease. That's one. Um, risk for stroke, heart attack, that kind of stuff. Carrier. Amber, can you elaborate?
Yup. There you go. Perfect. Yeah, it's kind of, yeah, it's kind of, it helps facilitate the metabolism. This, um, let's see what else do we have in here? Okay. That's it. We've got like two minutes before Nicole jumps on and I, if you have a question that you absolutely, uh, want to ask me about lab panels, I will be happy to. Um, I think you've jumped on out. We've been on for like may five minutes, five or six minutes. If you guys have no questions and you really want to see Nicole session, I encourage you to go do that. Um, we can always, you know, I'm gonna be back on later this afternoon. If you guys have a question about this session, um, that you absolutely wanted to know, just write it down and come back. I'll be on it to a central time. Why do we dump the first year?
And it has to do with timing. So let's say a patient hasn't voided for six hours. So let's say a patient there, let's say, let's say you take a Foley, right? Yeah. They have a foley. Well, what we're doing is we're actually looking at, um, let's say you take the Foley out at noon and then they want to start a 24 hour urine. Well, all of the urine that has been in the bladder for that past six hours is now an artifact. Or if there was some sort of like maybe residual medication and they wanted to try to wait for it to clear. So what you do is if that, that thing is residual in there, you want to make sure that they avoid it all out and that basically you say, I'm starting, I'm starting totally fresh. Does that make sense? Yeah. So there's the possibility of contamination.
There's possibility of other variables that are going to effect the results. Um, like my wife when she was in the hospital for pre, um, when our twins were born, she had uh, uh, Preeclampsia and she was filling a bunch of protein in the urine. So you actually want to know how much protein is being spilled in the urine. So let's say you get that protein accumulation for the previous six hours because she hadn't gone. Now all of a sudden likelihood that she would not go in six hours with twins. It's very unlikely. But that being said, if there was some sort of something in there that said, hey, for the next six hours we need, you know, we want to make sure that we started over. Uh, let's see, remit, ABC infection, infection, inflammation, anemia, leukemia. Yup. Those are the four. So yeah guys, if you have any questions, I will be glad to stay on and answer them for you.
If not, I encourage you to go over to Nicola session and check that one out cause I know that that one is going to be super fun. I'm actually going to jump on just as soon as I'm done here. Um, but yeah, if you have an also, if you have a question from this morning that you really wanted to, uh, to ask, I'll be back at 2:00 PM central time to do on a cardiac labs. We'll go over different types of cardiac labs. So, um, if you have any questions, please answer. Ask them now. Ob Glad to, to do that for you. If nobody has any questions, then what I'm going to do for those of you who, who may still be here, I'm going to ask you to do one little favor for me.
I'm going to drop this. Uh, we'd like to get some user feedback, so we want to make sure that we're giving you guys everything that you need. Uh, so we want to, in doing that, we ask that you guys fill out a little survey for us just to give us some information. So saw that everybody's leaving, which is totally okay. I'm down for that. Um, if you're still on, if you're still interested, that certainly takes like five seconds to fill out, just to let us know how you're doing or how we're doing. Um, in terms of, uh, all the content that you need, and maybe some suggestions in terms of content or times or things that may, uh, that work well for you. Uh, we always like to hear that, so they'll check out Nicole session if you haven't. Um, like we always say, go out and be a restful state and as always, happy nursing.
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