Sepsis Labs

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Chance Reaves
MSN-Ed,RN
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Included In This Lesson

Study Tools For Sepsis Labs

Toxicity Sepsis- Signs and Symptoms (Mnemonic)
Shock – Signs and symptoms (Mnemonic)
Shock (Cheatsheet)
63 Must Know Lab Values (Book)
WBC Differential Lab Value (Picmonic)
Blood Acid-Base Control (Picmonic)
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Outline

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

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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!!

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MS2EXAM1

Concepts Covered:

  • Circulatory System
  • Emergency Care of the Cardiac Patient
  • Cardiac Disorders
  • Medication Administration
  • Central Nervous System Disorders – Brain
  • Shock
  • Shock
  • Urinary System
  • Adult
  • Respiratory Emergencies
  • Cardiovascular Disorders
  • Postpartum Complications
  • Emergency Care of the Neurological Patient
  • Neurological Emergencies
  • Emergency Care of the Respiratory Patient
  • Pregnancy Risks
  • Vascular Disorders
  • Noninfectious Respiratory Disorder
  • Respiratory System
  • Cardiovascular
  • Endocrine and Metabolic Disorders
  • Hematologic Disorders
  • Disorders of the Adrenal Gland
  • Neurologic and Cognitive Disorders
  • Upper GI Disorders
  • Lower GI Disorders
  • Nervous System
  • Labor Complications
  • Liver & Gallbladder Disorders
  • Oncology Disorders
  • Substance Abuse Disorders
  • Renal and Urinary Disorders
  • Integumentary Disorders
  • Renal Disorders
  • Gastrointestinal Disorders
  • Acute & Chronic Renal Disorders
  • Respiratory Disorders
  • Disorders of Pancreas
  • Disorders of the Posterior Pituitary Gland
  • Endocrine
  • Gastrointestinal
  • Renal
  • Endocrine System
  • Disorders of the Thyroid & Parathyroid Glands
  • Integumentary Disorders
  • Musculoskeletal Trauma
  • Urinary Disorders

Study Plan Lessons

EKG Basics – Live Tutoring Archive
Dysrhythmia Emergencies
Electrical Activity in the Heart
EKG (ECG) Waveforms
The EKG (ECG) Graph
Normal Sinus Rhythm
Sinus Tachycardia
Sinus Bradycardia
Supraventricular Tachycardia (SVT)
Atrial Flutter
Atrial Fibrillation (A Fib)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Procainamide (Pronestyl) Nursing Considerations
Sympatholytics (Alpha & Beta Blockers)
Verapamil (Calan) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Dysrhythmias Labs
Dysrhythmias for Certified Emergency Nursing (CEN)
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Electrolytes Involved in Cardiac (Heart) Conduction
Nursing Care Plan (NCP) for Cardiomyopathy
3rd Degree AV Heart Block (Complete Heart Block)
2nd Degree AV Heart Block Type 2 (Mobitz II)
1st Degree AV Heart Block
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Advanced Cardiovascular Life Support (ACLS)
Acute Coronary Syndrome (ACS)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Obstructive Heart (Cardiac) Defects
Heart (Heart) Failure Exacerbation
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
02.09 12 Lead EKG- Leads 1, 2, 3, aVL, and aVF for CCRN Review
02.14 Shock Stages for CCRN Review
02.15 Hypovolemic Shock for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Distributive Shock
Sepsis Labs
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Sepsis Concept Map
Ischemic (CVA) Stroke Labs
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
ACLS (Advanced cardiac life support) Drugs
Electrical A&P of the Heart
02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
ARDS Case Study (60 min)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Acute Respiratory Distress
HELLP Syndrome
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology for Heart Failure (CHF)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Rapid Sequence Intubation
Trach Suctioning
Trach Care
Pacemakers
Myocardial Infarction (MI) Case Study (45 min)
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
Fluid Volume Deficit
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
02.02 Cardiomyopathy for CCRN Review
Hydralazine
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Nursing Case Study for Rheumatic Heart Disease
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
Coronary Artery Disease Concept Map
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Anti-Platelet Aggregate
Nursing Care Plan (NCP) for Cardiogenic Shock
Mixed (Cardiac) Heart Defects
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Angina
Hemodynamics
Preload and Afterload
Nursing Care and Pathophysiology for Cardiogenic Shock
MI Surgical Intervention
Heart Failure for Certified Emergency Nursing (CEN)
02.05 Calculating PAWP on PEEP for CCRN Review
Heart Failure 2 – Live Tutoring Archive
Nitro Compounds
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology for Valve Disorders
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Gastritis
Gastrointestinal (GI) Bleed Concept Map
Methylprednisolone (Solu-Medrol) Nursing Considerations
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Parasympathomimetics (Cholinergics) Nursing Considerations
Peptic Ulcer Disease Case Study (60 min)
Tocolytics
Cholecystitis for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care Plan (NCP) for Cholecystitis
Cirrhosis Case Study (45 min)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Cirrhosis for Certified Emergency Nursing (CEN)
Esophageal Varices for Certified Emergency Nursing (CEN)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Hepatitis for Certified Emergency Nursing (CEN)
Liver Cancer
Liver Function Tests
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Liver Cancer
Bowel Obstruction Concept Map
Epispadias and Hypospadias
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan for Hiatal Hernia
Cirrhosis Case Study (45 min)
Colorectal Cancer (colon rectal cancer)
Encephalopathy Case Study (45 min)
Fluid Shifts (Ascites) (Pleural Effusion)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Liver Cancer
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Liver Cancer
Nursing Case Study for Hepatitis
Stomach Cancer (Gastric Cancer)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care Plan (NCP) for Cholecystitis
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Acute Abdomen for Certified Emergency Nursing (CEN)
Appendicitis
Appendicitis for Certified Emergency Nursing (CEN)
Dialysis & Other Renal Points
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Peritoneal Dialysis (PD)
Peritonitis for Certified Emergency Nursing (CEN)
Cystic Fibrosis (CF)
Diabetes Mellitus (DM) Module Intro
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Metabolic Acidosis (interpretation and nursing diagnosis)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Case Study for Diabetic Foot Ulcer
Nursing Case Study for Type 1 Diabetes
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
03.02 Diabetes Insipidus for CCRN Review
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Enuresis
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Diabetes Insipidus
03.04 DKA vs HHNK for CCRN Review
05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review
09.05 Chronic Renal Failure for CCRN Review
Adrenal Gland
Diabetes Management
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Gestational Diabetes (GDM)
Glipizide (Glucotrol) Nursing Considerations
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia
Injectable Medications
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin Drips
Insulin Mixing
Insulin Mnemonic (Ready, Set, Inject, Love)
IV Infusions (Solutions)
IV Pump Management
Hyperthyroidism Case Study (75 min)
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
09.02 Acute Tubular Necrosis for CCRN Review
Burn Injuries
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Compartment Syndrome for Certified Emergency Nursing (CEN)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for Gastritis
Wound Care – Assessment
Wound Care – Selecting a Dressing