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01.01 Lab Panels

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Overview

  1. Lab Panels
    1. What are different lab panels?
    2. Metabolic Panels
    3. Complete Blood Counts
    4. Liver, renal and other panels

Nursing Points

General

  1. Different lab panels
    1. Provides information quickly to providers
    2. Can include more than one system
    3. Often performed in hospital
    4. Based on systems
    5. Can be simple or complex
      1. The more complex the lab panel, the longer it takes to receive results
  2. Metabolic panels
    1. Basic Metabolic Panel (BMP)
      1. BUN/Creatinine
        1. Dehydration/kidney function
      2. Glucose
        1. Blood sugar levels
      3. Electrolytes
        1. Potassium (accidentally replaced with Calcium  in slide)
        2. Chloride
        3. Sodium
        4. Potassium
        5. Bicarbonate
    2. Comprehensive Metabolic Panel
      1. Liver function tests
        1. Alkaline Phosphatase (ALP)
        2. Alanine transferase (ALT)
        3. Aspartate aminotransferase (AST)
        4. Bilirubin
      2. Renal function
        1. BUN
        2. Creatinine
        3. GFR
      3. Glucose
      4. Proteins
        1. Albumin
        2. Total protein
      5. Electrolytes
        1. Sodium
        2. Chloride
        3. Calcium
        4. Bicarbonate
        5. Potassium
    3. *NOTE* – neither metabolic panel includes Magnesium or Phosphorus – those need to be ordered separately
    4. Complete Blood Counts
      1. Red Blood Count
      2. White Blood Count
      3. Hemoglobin/Hematocrit
      4. Platelets
      5. Other values
        1. MCH/MCHC
        2. MCV
        3. RDW
      6. Differential
    5. Other panels
      1. Liver Function Tests
        1. ALP
        2. AST
        3. ALT
        4. Bilirubin
        5. Proteins
        6. PT/INR (Coagulation studies)
      2. Renal Panel
        1. BUN
        2. Creatinine
        3. Urinalysis
        4. Electrolytes
        5. GFR
  3. Nursing Concepts

  1. Lab Values
  2. Patient-Centered Care

Patient Education

  1. Educate patient on lifestyle changes that can improve lab values

Reference Links

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Video Transcript

Okay guys in this lesson we’re going to take a look at the different types of lab panels that you may run across when you’re taking care of your patients.

The beauty of these types of tests are that they can provide information quickly and they usually include more than one system. So you can take a look at your patient’s electrolytes and liver function at the same time without submitting two different types of tests. Another beautiful part of it is that they’re often performed on site, meaning that the hospital lab can perform these tests usually without a problem. That means that you get your information back quickly. It gives information about the different systems and all of the values can help point to what’s going on with your patient. These tests can be simple or they can be really complex. One thing that you want to keep in mind is if you have a patient that’s becoming sick pretty rapidly, you’re going to want to get labs that are going to give you the most information quickly.

Let’s start off by taking a look at the two most common types of metabolic panel. The first one is called the basic metabolic panel, or BMP. There are some similarities between the two panels that we’re looking at, but the thing that you want to look at when you’re looking at BMP is that it gives you a snapshot at kidney function, blood sugar, and electrolytes. The BUN and creatinine are going to give you an idea of what’s going on with the kidneys and how well they’re functioning. The glucose is going to give you an idea of sugar levels, and all of these electrolytes here give you an idea as to what your patients electrolyte status is. Again we go into all the little nuances of each lab value and other lessons so go check those out.

Like your BMP, your comprehensive metabolic panel or CMP, is going to give you your kidney values, your blood sugar levels, and your electrolyte levels. But it also gives you a lot more information. Here you can see that it gives you an idea of what’s going on with your liver with your Alk Phos, ALT, and AST. It also gives you some insight as to what’s going on with your patient’s protein levels. Don’t forget that the CMP is probably going to take longer to get back, so if you need some quick response as to what your patients electrolytes and kidneys are doing, then I would send out for a BMP vs. CMP.

The big thing that you need to understand between these two panels is that one is very basic and it gives you some real simplistic results, whereas another one is extremely complex, but if you need those values you can get them through these panels.

Another common type of lab test that you’re going to see is going to be the complete blood count or CBC. This is a really interesting test, and it’s a really common one. What it does is it gives you an idea about what’s going on with your patient’s cells. With your patients red blood cell count, or RBC, it can give you an idea as to if they have different types of anemia, along with your hemoglobin and hematocrit. Another thing that your CBC will do is it’ll give you some information about your patients immune system, through the white blood cells. It can tell you if there’s inflammatory response is happening, if there’s an infection going on, or even some possibilities of disease processes like leukemia. One really important thing that you’re going to have to think about when you’re doing a CBC is if they need a differential. A differential is a specific type of test that looks at all the different types of white blood cells. All of these white blood cells have specific roles, and sometimes you have to know exactly how many there are. Again like other values that we’re talking about in this lesson go check out the specific lessons regarding each one of these values so that you can get a better understanding of what all of these mean so that when you see them in your patient CBC you understand.

The other thing it’ll do is it’ll take a look at platelets, which is really important for clotting. So by comparing all of these values together, you can see if your patient maybe has an indication for a certain disease, or if they’re at risk for disease or if they’re at risk for some complication. That’s the point of this lab panel, is that they give you a broad picture of what’s going on with your patient by checking on multiple systems at the same time.

You’re probably also going to see other types of panels, things like liver function tests which are much smaller and they only cover values important to the liver. But because they have multiple values they fit into that subcategory of liver function test. Renal panels are the exact same way. They took a look at specific kidney function, but they also will possibly look at proteins or a urinalysis or electrolyte balance. Even though you have two specific values that we look directly at the kidneys, we can do these renal panels which give us more information about the patient as a whole. There are also other tests like lipid panels, or cardiac markers, or even electrolyte panels. They all have their specific purpose and it’s important to understand where they fit into the grand scheme of you taking care of your patient.

Now for this lesson it was really important that we took a look at the nursing concepts of lab values and patient-centered care one we’re talking about the different types of lab panels for your patient.

So let’s recap.

First understand that these different types of lab panels give you a big picture of what’s going on with your patient metabolically. It tells us more about how their systems are working all together.

Don’t forget that the more complex the lab test is, the longer it takes to get results. So if you have a patient in these results pretty quickly think about getting the minimal panel for that patient.

When you’re looking at your two main panels like your BMP and your CMP, remember that the BMP is going to cover your kidneys, electrolytes, and glucose. And that your CMP is your BMP plus liver functions and proteins.

Don’t forget about your CBC, because that gives you insight into possibility of infection, inflammation, leukemia and anemia.

And lastly, there are lots of different lab test out there, So this isn’t a comprehensive list in any way. But what you need to remember is that they’re often other tests that give us bigger snapshots of specific symptoms, like liver function tests, or renal panels.

Now that’s it for our lesson on lab panels. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

  • Question 1 of 10

Prior to back surgery, the provider has ordered a complete blood count for a client. Which best describes the purpose of performing this test before surgery?

  • Question 2 of 10

A provider orders a CBC for a male client who has been admitted to the hospital for pneumonia. Which of the following results would be considered abnormal on the CBC? Select all that apply.

  • Question 3 of 10

A client who is preparing for surgery will receive a CBC to check a platelet count before the procedure. When providing information to the client about the test, which data should the nurse include?

  • Question 4 of 10

A client is admitted to the healthcare clinic for symptoms of anxiety, weight loss, and a goiter. The provider suspects that the client has Graves’ disease. Which of the following lab test orders would the nurse expect to see in order to diagnose this condition?

  • Question 5 of 10

A nurse is performing a pre-op assessment and physical on a 55-year-old client who will be undergoing surgery. Which of the following laboratory tests would most likely be drawn before a surgical procedure? Select all that apply.

  • Question 6 of 10

A nurse is checking laboratory results for a client with TPN and lipids and notes the following: Sodium: 138 mEq/L Potassium: 4.1 mEq/L Calcium: 10.1 mg/dL Albumin: 5.4 g/dL Triglycerides: 426 mg/dL Alkaline Phosphatase: 100 IU/L Based on these laboratory results, which of the following actions is most appropriate?

  • Question 7 of 10

Which of the following lab values are typically monitored when a client is receiving TPN? Select all that apply.

  • Question 8 of 10

A child is brought into the emergency department with severe injuries. The physician orders a transfusion of one unit of whole blood to be administered immediately. The nurse has completed a rapid assessment of the child but there are no laboratory results available to know the child’s blood type. Which of the following actions of the nurse is most appropriate?

  • Question 9 of 10

The nurse is caring for a client who has been on a heparin drip for 3 days for a pulmonary embolism. The day the drip was started, the client’s platelet count was 152,000. Yesterday’s CBC showed a platelet count of 90,000. The nurse notes that today’s CBC reveals a platelet count of 68,000. What is the nurse’s next priority at this time?

  • Question 10 of 10

A nurse has three clients who are receiving lab work in the morning at the beginning of the shift. The nurse reviews the results after they come in and notes the following: Client A: Sodium 133 mEq/L. Client B: Blood glucose 186 mg/dL. Client C: Chloride 100 mEq/L. In which order would the nurse see these clients?

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