Lab Values and Critical Interventions

BNP (Brain Natriuretic Peptide)

• Indicates congestive heart failure (CHF).
• Normal range: Less than 100.
• Elevated BNP indicates CHF; the higher the BNP, the worse the CHF.
• CHF is generally a chronic condition (not an acute crisis).

Sodium Level

• Normal range: $135 0 145$
• Low priority (letter B).
• Low sodium (hyponatremia): Look for fluid overload.
• High sodium (hypernatremia): Look for dehydration.
• General Rule: If a value is high and you're unsure, suspect dehydration.

Complete Blood Count (CBC) Values

• Includes white blood cells (WBC), platelets, and red blood cells (RBC).

White Blood Cells (WBC)

• Involved in inflammation, immunity, and allergic reactions.
• Three important white counts for nurses to know:
  • Total WBC count: $5,000 0 11,000$ cells per cubic millimeter.
  • Absolute Neutrophil Count (ANC): Indicates bacterial infection; should be above 500.
  • CD4 Count: Relates to T lymphocytes in HIV; should be above 200.
• Low White Count Synonyms:
  • Terms to memorize are in the resource notes.
• Prioritizing White Counts:
  • Total WBC below 5,000: Critical (Level C).
  • ANC below 500: Critical (Level C).
  • CD4 count below 200: Critical (Level C).
  • Critical values indicate immunosuppression and susceptibility to infections.
• Actions for Critical White Counts:
  • Implement leukopenic or neutropenic precautions.
  • Also known as reverse isolation or protective isolation.
  • Includes immunosuppression protocol and bone marrow protocol.
  • A list of neutropenic precautions is available in the resource; requires memorization.

Platelet Count

• Platelets are clotting cells that aid in coagulation to stop bleeding.
• Normal range varies by source (approximately $150,000 0 400,000$).
• Emphasis is on recognizing low platelet counts (thrombocytopenia).
• Low Platelet Count:
  • Thrombocytopenia: low platelet count (term to know).
  • Platelet count below 90,000: Letter C; risk of bleeding.
    • Actions:
      • Assess for bleeding.
      • Call the healthcare provider.
      • Implement thrombocytopenic protocol/bleeding precautions (refer to resource list for specifics).
  • Platelet count below 40,000: Letter D; risk of spontaneous bleeding to death.
    • Actions:
      • Assess for bleeding.
      • Call the healthcare provider.
      • Implement thrombocytopenic protocol/bleeding precautions.
      • Transfuse platelets.
        • Trigger value for platelet transfusion: Platelets under 40,000.

Red Blood Cells (RBC)

• Normal range: $4 0 6$ million.
• Abnormalities are a lower priority (letter B).
• Assess for bleeding or malnutrition.

Summary and Analysis

• Key Takeaway: Prioritize the letter D values (dangerous/deadly).
• Memorize the five D's to ensure patient safety.
• The Five D's:
  • Potassium in the sixes and higher ($≥ 6$).
  • pH in the sixes and lower ($≤ 6$).
  • CO2 in the sixties and higher ($≥ 60$).
  • O2 in the sixties and lower ($≤ 60$).
  • Platelet count below 40,000.
• Memorize actions for letter C values.
• Do not prioritize memorizing letter A's and B's (low priority values).
• Focus on high-priority values (C's and D's), deeming everything else of lower concern.

Rapid Response Team

• Call a rapid response team for symptomatic D’s.
• If a patient has a D value but is asymptomatic, manage within the unit.
• If a patient has a D value and is symptomatic, call a rapid response team.
  • Example: A patient with a CO2 of 64 (a D) who is dyspneic requires a rapid response team.