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Nursing 220 Lab Interventions

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					                         DIAGNOSTIC LAB STUDY INTERVENTIONS - NSG 220

               Lab Study                                       Interventions
T & CM                                 Assess:
                                       -decreased H & H
                                       Interventions:
                                       -identify type, Rh.
                                       Orders:
                                       -identify number of units available

Thyroid                                Assess:
   Decreased T3, T4                    -fatigue, lethargy, cold intolerance, dry skin, weight gain,
   Elevated TSH                         constipation, decreased pulse and B/P, slow mental ability
                                       Interventions:
                                       -provide rest periods
                                       Orders:
                                       -administer levothyroxine (Synthyroid)

Thyroid                                Assess:
   Elevated T3, T4                     -tachyarrhythmias, hunger, weight loss, heat intolerance,
   Decreased TSH                        insomnia, exophthalmos, nervousness
                                       Interventions:
                                       -provide extra calories, between meal snacks, increase
                                        fluids, no caffeine
                                       -provide rest periods and quiet environment
                                       Orders:
                                       -administer Beta Blockers, PTU, Tapazole

FBS and/or Hgb A1C                     Assess:
  Elevated                             -polyphagia, polydipsia, polyuria, fatigue, weight loss, DKA,
                                        HHNS
                                       -cause: diabetes, steroid use, stress, TPN
                                       Interventions:
                                       -teach importance of tight glucose control with diet, meds,
                                        and exercise
                                       Orders:
                                       -maintain diabetic diet
                                       -administer insulin and/or oral antidiabetic medications

Prealbumin, Albumin, and               Assess:
Total protein                          -malnutrition (decreased protein and calcium), edema,
   Decreased                            infection, poor wound healing, and skin breakdown
                                       -liver abnormalities - jaundice, itching, N/V, increased
                                        bilirubin
                                       Interventions:
                                       -skin care, protect from infection
                                       -fluid and Na restrictions, increase protein in diet
                                       Orders:
                                       -administer TPN
                                       -administer diuretics, albumin




NSG 220 Diag/lab interventions
Amylase and Lipase                  Assess:
  Increased                         -hypovolemia, LUQ, epigastric pain, N/V
                                    -complications: hypocalcemia, hypokalemia, hyperglycemia,
                                     jaundice
                                    Orders:
                                    -administer pain medications
                                    -NPO, administer IV fluids
                                    -administer antiemetic and possible NG insertion
                                    -administer antibiotics

Total bilirubin                     Assess:
   Elevated                         -jaundice, itching, icteric sclera, clay colored stool, amber
                                     urine, N/V
                                    -intolerance to fatty foods, anorexia
                                    -abdominal pain in RUQ or LUQ
                                    -bruising, and bleeding
                                    Interventions:
                                    -tepid bath, oatmeal soap-Aveeno, cool environment
                                    Orders:
                                    -administer cholestyramine (Questran).
                                    -administer fat soluble vitamins A, D, E, K

Direct (conjugated) bilirubin       -as above with total bilirubin
   Elevated                         Assess :
                                    -S & S of obstructive jaundice (especially from
                                     gallstones). RUQ pain, N/V, intense stabbing epigastric
                                     pain

Indirect (unconjugated) bilirubin   -as above with total bilirubin
    Elevated                        Assess:
                                    -liver dysfunction cirrhosis, cancer, and hepatitis

AST and ALT                         Assess:
   Elevated                         -bone or liver abnormalities - bone pain, jaundice, itching,
                                     elevated bilirubin, and N/V
                                    Interventions:
                                    -safety measures to prevent fractures

AST and ALT                         Assess:
   Decreased                        -malnutrition
                                    Interventions:
                                    -increase protein, vitamins, and calcium in diet

Alkaline Phosphatase                Assess:
   Elevated                         -bone and liver abnormalities - bone pain, jaundice, itching,
                                     elevated bilirubin, and N/V
                                    Interventions:
                                    -safety measures to prevent fractures




NSG 220 Diag/lab interventions
Ammonia                          Assess:
  Elevated                       -cirrhosis and liver cancer
                                 -disorientation, tremors, asterixis, decreased coordination,
                                  decreased LOC, elevated liver function studies
                                 Interventions:
                                 -reorient frequently
                                 -safety precautions
                                 Orders:
                                 -administer low protein diet and/or enteral amino acid
                                  formula
                                 -administer Neomycin
                                 -administer Lactulose, Cephulac
                                 -if GI bleeding prepare for gastric lavage to remove blood
                                 -If hypokalemic, administer K+ to keep levels normal

Hepatitis Screen                 Assess:
   Positive                      -slight fever, GI upset, anorexia
                                 Interventions:
                                 -provide rest, decrease stress, balanced diet
                                 -teach hand washing, safe sex practices, food handling, and
                                  how to avoid spreading disease
                                 -teach no alcohol or acetaminophen
                                 Orders:
                                 -administer Interferon for Hep. B/C and Y-globulin for A
                                 -teach hand washing, safe sex practices, food handling, and
                                  how to avoid spreading disease
                                 -teach no alcohol or acetaminophen

C. difficile toxin               Assess:
    Positive                     -frequency, color, and odor of stools
                                 Interventions:
                                 -contact isolation, obtain bedside commode,
                                 -provide perirectal skin care
                                 Orders:
                                 -administer antibiotic

Occult blood in stool            Assess:
  Positive                       -anemia, fatigue, decreased H & H
                                 Interventions:
                                 -teach follow up screening and possible colonoscopy

CEA level                        Assess:
  Elevated                       -change in stool pattern, caliber, and frequency
                                 -colon/breast cancer, heavy smoking, cirrhosis, ulcerative
                                  colitis, diverticulitis, peptic ulcer, or pancreatitis
                                 Interventions:
                                 -provide emotional support

Urinalysis                       Assess:
    +glucose                     -hyperglycemia, DKA, HHNS
    +ketones                     -elevated blood glucose monitoring results.
    +microalbumiuria             Interventions:
    +protein                     -teach importance of tight glucose control via meds, diet,
                                 and exercise
                                 Orders:
                                 -administer insulin and oral anitdiabetic medication




NSG 220 Diag/lab interventions

				
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