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Okay guys in this lesson we’re going to teach you how to do shorthand for your lab values
These are the two typical of Skeletons that you’re going to see for your Chem 7 or your Chem 10. This one is your Chem 7, or your basic metabolic panel or BMP. This is going to allow you to plug in on your values here.
So let’s say you get your values back on your patient, and you need to know where they go. This is how I remember. You always start with sodium in this top corner, and then next to it is chloride because it’s sodium chloride always go together. Directly below your sodium is where your potassium goes because you always want your electrolytes together. In this far side you’re going to have your glucose and then the last two values that you have are your BUN and creatinine, and they always need to go together. So bun goes on top and creatinine goes on the bottom. So we have this final space that we need to fill, that’s where your bicarb or your CO2 is going to go.
Now let’s say your fighter wants to add calcium, magnesium, and phosphate. Well that doesn’t go in this chem 7 skeleton, so you throw in this guy. The way I remember this one is is alphabetical order so calcium is on top, then you have mag to the bottom left and then phos to the bottom right.
So let’s actually try this. Here’s our Labs back on our patient. So like we said in the beginning, we’re going to start with sodium. sodium is 142, so you’re going to put it in the top left corner. The next when you’re going to look for is your chloride cause your sodium and chloride to go together so the next box is 106. Below your sodium is going to be your potassium which is 4.6, and then you’re going to add in your glucose all the way over here on the right at 91. The next two volumes you should be looking for your BUN and creatinine so The BUN is 9, it goes on top and then the creatinine is 0.8 and that goes directly below it. And lastly we want to throw in that bicarb in this empty space, and that’s 25.
Now if you’ll notice there were no abnormal values. But let’s say the glucose was 150. That’s outside of range . We’re going to do is write down 150, and circle it, so that you know that it’s abnormal.
So if you look at this Chem panel, you we can also see that we’ve got calcium magnesium and phosphate. We need to plug those values into our skeleton. So calcium goes on top, and that’s 10.3. Now you’re next when you’re going to do is your mag which is 2.0 and that goes on the bottom left, and then plug in that last value of the phos which is 3.0. Again these are all normal values, so we’re not going to circle any of them.
Now I know that was a lot in the last lied, but now that you have some sort of idea of what’s going to happen, it’s going to get faster. New paragraph. This is a skeleton for the CBC. There are a lot of components to a CBC, but we’re going to look at the really important ones.
And the skeleton we look at four main values, which are white blood cell count, hemoglobin, hematocrit, and platelets. White blood cells go in the first open spot. Then you have your hemoglobin and hematocrit, and those two always go together. Siri hemoglobin goes on top, and your manicure goes on the bottom, and in this last spot we want to put the platelet.
So if we do our practice one here are white blood cells are 5900. But we don’t want to write 5900. What we want to write is 5.9. Hemoglobin is 15, so we put 15 in the top, and the the hematocrit is 42.6%, and we want to put that on the bottom. Just like with the white blood cells, we don’t want to write 174000 for are platelets. We just want to write 174 because we understand that they’re measured in thousands.
Now I’m sure you’re wondering where the red blood cells fit in, but it’s not put in the skeleton. Just know that for a quick reference that your red blood cells should it be about a third of your hemoglobin. So if we look at these values we can see that 1/3 of 15, is five and are RBC about you is 5.2 which is good for this patient.
For our liver values there are a couple of different skeletons that you can use with the one that we are going to use here is the one that looks like an x. The reason we should use this one, is because it’s simplistic, and it really hits the values that we really need to know.
Starting at the top is your bilirubin measurements. You always start with your total bilirubin, and right underneath it you’re going to write your direct bilirubin. Those two values go in this top space. Then go clockwise, and you’re going to plug in your alt value. The other way that I remember where the others values go is directly across from it is the AST. Then the last value that we need to know is your alkaline phosphatase and that goes in the bottom spot. This is not as easy to remember as some of the other skeletons, so you’re going to need to practice with this one.
Speaking of let’s do one. So we’re going to start with the total bilirubin. It’s 0.1 and it goes in that top space and right underneath it is 0.1. Next will move to the alt, and in this patient it’s 20, directly across from that is the AST and that’s 25. Again these are all normal value so we’re not going to circle any any of them. Last we want that Al Kloss and that goes in the bottom and that value is 50.
I like with your liver function test, the skeleton for the ABG is going to require a little bit of practice. But what you want to remember is that you go right down the line with your ABG.
Your first value is your pH, And you follow that with your CO2, then your oxygen, and then by car. The next one is your oxygen saturation, so make sure that you pay attention to the two little differences, and that’s why I say you need to practice this one. That last spot is going to be for your base excess. So let’s do one.
Our values for the pH for this patient is 7.4 and it goes in that first spot. Next is going to be your CO2, and that’s 40 and we’re going to follow that with our oxygen and that’s 98. Are patient’s bicarb is 25 and that goes here, and then the patient’s oxygen saturation is 99% and it goes in the spot. The last one is your base excess which is 0, and that goes in this final spot here.
Again this is going to take some practice so make sure you take some time to set the skeletons up and practice practice practice
The last one that we’re going to look at is our coag studies.
This one’s going to be a little bit easier to remember because you only have to remember three values. The first two are PT and PTT. Sometimes you’ll see PTT written as aPTT, but they’re the same value. The way I remember this is that PT is shorter than PTT, so it goes in the first spot. Then your PTT goes right next to it. And in your final spot below both of them is your INR.
So let’s do one. This patient’s PT is 11 seconds, and goes in the first spot. The next one is the PTT and that’s 33 seconds and it goes right next to it. And below it is going to be your INR which is one. Again none of these values are abnormal so we’re not going to circle any of them. But let’s say your patients PTT is 120 seconds, we’re going to make sure that we circle that one. You have a patient that’s on some sort of anticoagulant therapy like Heparin or Warfarin, the skeleton is going to be your best friend. So learn this one that way you can quickly reference it especially if you’re doing like a Heparin drip because you’re going to have to go back and see what the last value was so that you can make adjustments to your trip.
Okay guys for today’s nursing concepts really focused on lab values and communication by doing the shorthand tips and tricks.
So let’s recap.
You’re going to have to practice guys, there’s just no way around it in order to use these things. But the more you do it the better you’re going to get at it.
The next thing you want to do is always Circle those that normal values so that you can flag them to yourself.
One thing that I want to mention is that reference ranges are always going to be the same, and that’s really based on the lab itself. So make sure that your pay attention to what the actual reference ranges are in your facility.
Make sure that you figure out a way to keep them handy and make a routine by doing them the same way every time so that you always know where those values are quickly.
Always use them, help you help yourself. You’re going to make your shift to go more efficiently, and you’re going to provide better care of your patients
I know this lesson was a little bit longer, but just know that you guys did great and I know that you’re going to use these things.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!!