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07.04 Sepsis Labs

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Overview

  1. Sepsis
    1. Labs to consider for disease process
    2. Lab purposes
    3. Special Considerations

Nursing Points

General

  1. Sepsis
    1. Labs to consider for disease process
      1. Comprehensive/Basic Metabolic Panel plus electrolytes
      2. Complete Blood Count
      3. Type and screen
      4. ABG
      5. Coagulation Studies
      6. Lactate
      7. Cardiac markers
      8. Cultures
    2. Lab purposes
      1. Comprehensive/Basic Metabolic Panel plus electrolytes
        1. Organ function
        2. Electrolyte imbalances
        3. Monitoring Anion Gap
      2. Complete Blood Count
        1. Infection
          1. Degree of infection
          2. Stimulation of bone marrow
        2. Inflammation
      3. Type and screen
        1. Needed for transfusions
      4. ABG
        1. Check blood pH (will trend)
        2. Send on ice
        3. Will be done in ABG syringe
      5. Coagulation Studies
        1. Early onset or onset of clotting abnormalities
      6. Lactate
        1. Trending of lactic acid
        2. Send on ice
      7. Cardiac markers
        1. Troponins
        2. Monitoring for demand ischemia or myocardial cell injury
      8. Cultures
        1. Identify pathogens
        2. Check for sensitivity
    3. Special Considerations
      1. Comprehensive/Basic Metabolic Panel plus electrolytes
        1. Green top
      2. Complete Blood Count
        1. Lavender top
      3. Type and screen
        1. Pink top
      4. ABG
        1. ABG Syringe
        2. Send on ice
      5. Coagulation Studies
        1. Blue top
      6. Lactate
        1. Gray top
        2. Send on ice
      7. Cardiac markers
        1. Green top
      8. Cultures
        1. Blood cultures
          1. Aerobic/Anaerobic jars
        2. Swabs
          1. Area of concern
          2. Check with policy

Nursing Concepts

  1. Infection Control
  2. Lab Values

Reference Links

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Video Transcript

In this lesson we’re going to take a look at what labs we would expect to find for a patient if we’re suspicious that they have sepsis.

Just like all of our other lessons similar to this, what we’ve done is we’ve compiled the list of the most common types of labs when you’re probably going to see for your patients with different conditions, diseases, or illnesses. This is not a comprehensive list that includes absolutely every type of test that you’re ever going to run on your patient with every type of condition, but they’re the most common types that we’re seeing here so let’s get started. Now sepsis is a common admission for a patient in the hospital, and we need to figure out what’s going on with them in terms of what’s causing their source of the infection. Once we identify the cause of the infection, then what we can do is identify the needs and support their care and the way we do this is through monitoring their labs.

Typically the most type of routine tests that you’re going to see if a patient that has sepsis are a comprehensive metabolic panel, and you’re going to check your electrolytes.

You are also going to see things like a complete blood count and a type and screen

You’re going to see some things like your arterial blood gas and your lactates, in addition to coagulation studies.

It some cases you can see different types of cardiac markers and most importantly we’re going to pay attention do cultures.

To get started we’re going to focus on our patient comprehensive or basic metabolic panel. We want to pay attention to the liver values, other organ functions, we went to pay attention to proteins and we also want to pay attention to the electrolytes. The electrolytes are going to give us a lot of information, especially for things like the anion gap. There is a good lesson on a anion gap so I encourage you to go check that out.

We’re also going to pay attention to the CBC because the CBC is going to tell us how well their body is protecting or responding to the infection. That’s going to tell us what degree of inflammation is occurring.

The other thing the CBC tells us is going to tell any type of anemia that may be happening.

You’re also probably going to get a type and screen on your patient, because some patients will receive blood transfusions throughout their stay. So you need to make sure that your patient is typed and cross-matched prior to giving them any blood.

Also one of the big things that we pay attention to his arterial blood gas. It’s going to tell if pH and it’s going to allow us to turn those over time. One thing that you really need to be mindful of is that your abg’s are always going to go on ice and they are usually in their own little syringe.

The other thing you’re going to trend is lactate which gives us an idea as to what type of lactic acid build-up is occurring. That’s going to contribute to the change in the ph, and you’re also going to send that on ice as well.

For these patients were also going to pay attention to different types of coagulation studies because sometimes they can have a systemic response where their ability to clot gets all haywire, so we need to pay attention to those.

The other thing we’re going to pay attention to is to cardiac markers. We want to check those troponins. And make sure that our patient heart muscles not being affected by the sepsis.

Also we are going to try to figure out some sort of source of infection by doing the culture. We’re going to either do a culture that we think is at the source, so sometimes those are wound cultures, but we also do something called a panculture, which basically means we’re going to culture everything. This means sputum, blood, urine, and you sort of suspicious area that we think is causing the type of systemic response to the infection.
So what do we need to think about when we’re sending these Labs off.

Well your metabolic panel your electrolytes and your cardiac markers are all going to go in a green top tube.

Your CBC is going to go in your purple top tube, and that’s the one that has EDTA in it to keep it from clotting.

Now remember that your ABG and your lactate also need to be on ice so don’t forget about that. But with your ABG is going to have its own particular syringe, and with your lactate is going to go in this grey top tube.

For cultures, we need to figure out where it’s coming from, so expect the pan culture your patient which means you’re going to be using these blood culture jars or you’re going to be swabbing some area that you may be suspicious that is the cause of infection

For a patient with sepsis, we focus on the nursing concepts of lab values and infection control

Okay so let’s recap.

For a metabolic panel in electrolytes, we’re looking at overall organ function and we’re going to continue to monitor for organ failure because that can be a common result of sepsis.

We’re going to use the CBC to monitor a patient’s level of infection, inflammation, and if they have any sort of anemia.

With your lactating your AVG you want to make sure that we’re turning those and we’re sending those on Ice.

Four cultures we won’t identify the cause of the infection, so that Source could either be blood, some sort of wound, the urinary tract, Etc. Just know that you may end up culturing everything in the process.

Lastly want to pay attention was quite relation studies, cuz we want to make sure that our patient isn’t developing some sort of clotting problem as a result of the sepsis.

And that’s our lesson on what lab values your comely going to see what your patient with sepsis.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!!