What VS data are
RELEVANT that • Total of both direct/indirect bilirubin STABLE
must be recognized • Bilirubin is metabolized by the liver and a broken down by-
as clinically product of heme protein in RBCs
significant by the • Relevant with any patient who has liver disease
nurse?
• Nonspecific hepatic iso-enzyme that has a large STABLE
1. What concentration in the liver, but found in other parts of the body
psychosocial/h • If primary liver disease, focus on ALT and AST; these are
olistic care much more specific to liver function
PRIORITIES • Relevant with any patient who has primary liver disease
need to be • Enzyme found in liver
addressed for • Released into circulation when liver cells are damage.
this patient?
2. What nursing • Relevant with any patient who has primary liver disease
WORSENING
priority (ies) • Enzyme found in liver
will guide your • Released into circulation when liver cells are damage.
plan of care? • The liver is responsible for filtering toxins from the blood,
(Management of producing important blood-clotting proteins, and aiding in
Care) digestion and metabolism. Cancer treatment (medications –
3. What MTX) have the potential to damage the liver. Liver function
educational tests determine whether the special proteins that are normally
/discharge found inside the liver cells are damaged and leaking out,
priorities causing elevated serum levels. Trending is necessary to
need to be monitor liver function.
addressed
to promote • Relevant with any patient who has primary liver disease WORSENING
health and • Enzyme found in liver
wellness for
• Released into circulation when liver cells are damaged
this patient
and/or • Has a higher specificity to liver than AST
family?
(Health
Promotion
and
Maintenance
)
What data must be
interpreted as
clinically significant
by the nurse?
(Reduction of Risk
Potential/Physiologic
Adaptation)
What data from the
histories is
RELEVANT and
has clinical
significance to the
nurse?
What assessment
data is RELEVANT
and must be
recognized as
clinically significant
© 2018 Keith Rischer/www.KeithRN.com
, by the nurse?
Ward, J. (2012).
Five
strategies
for a
culturally
competent
patient care.
Retrieved
from
http://www.
nursetogeth
er.com/5-
strategies-
culturally-
competent-
patient-
care#sthash.
BroQf68H.d
puf
Van Leeuwen,
A. & Bladh,
M.L.
(2015).
Davis’s
comprehens
ive
handbook of
laboratory
and
diagnostic
tests with
nursing
implications
. (6th ed.).
Philadelphi
a, PA: F.A.
Davis
Company.
Total Bilirubin: 1.0
Alkaline Phos: 75
© 2018 Keith Rischer/www.KeithRN.com
,ALT: 42
AST: 49
© 2018 Keith Rischer/www.KeithRN.com
, Lactate:1.8 • Remember Krebs cycle and lactic acidosis in A&P due to STABLE
anaerobic metabolism?
• GOLD STANDARD lab to trend with any shock state,
especially sepsis!
• Elevated levels correlate with higher likelihood of dying. For
example, in septic shock, a level >4 reflects a 28 percent
mortality
Lactate builds up within the serum and can be seen as a
marker of strained cellular metabolism
Ionized Calcium: • Represents Ca++ that is metabolically available compared to STABLE
1.05 serum Ca++ that is more generalized
• More accurate determinate of calcium
If low, serum calcium is usually also decreased
Magnesium: 1.9 • Essential to normal cardiac electrical conduction, as is K+
• If too high or low, can predispose to rhythm changes that can STABLE
be life-threatening!
Amylase: 29
• Digestive enzyme breaks down complex carbohydrates
STABLE
• Primarily formed in pancreas and will “leak” into
circulation with pancreatic inflammation
• Relevant with pancreatitis/cholecystitis and obstruction of
• Tonsillectomy at 3 years old under peer relationships to provide security and comfort as they work to gain
general anesthesia. independence from their parents. Children who feel alienated from their
Swanson, K. M. (1991). Empirical peer group may experience depression, impaired social development,
and poor school performance.
development of a middle range theory of
caring. Nursing Research, 40(3), 161–166.
Vallerand, A.H., Sanoski, C.A., & Deglin,
J.H. (2014) Davis’s drug guide for nurses.
(14th ed.). Philadelphia, PA: F.A.
4. State the rationale and expected
outcomes for the medical plan of
care. (Pharm. and Parenteral Therapies)
Sommers, M.S. & Fannin, E. (2015).
Diseases and disorders: A nursing
therapeutic manual. (5th ed.). Philadelphia,
PA:
SKINNY Reasoning
SKINNY Reasoning
school due to her illness and has not been
keeping in touch with her friends.
Clinical Significance:
Rex-Smith, A. (2007).
Something more than
presence. Journal of
Christian Nursing,
24(2), 82–87.
Reviewer
RELEVANT VS Data:
© 2018 Keith Rischer/www.KeithRN.com
RELEVANT that • Total of both direct/indirect bilirubin STABLE
must be recognized • Bilirubin is metabolized by the liver and a broken down by-
as clinically product of heme protein in RBCs
significant by the • Relevant with any patient who has liver disease
nurse?
• Nonspecific hepatic iso-enzyme that has a large STABLE
1. What concentration in the liver, but found in other parts of the body
psychosocial/h • If primary liver disease, focus on ALT and AST; these are
olistic care much more specific to liver function
PRIORITIES • Relevant with any patient who has primary liver disease
need to be • Enzyme found in liver
addressed for • Released into circulation when liver cells are damage.
this patient?
2. What nursing • Relevant with any patient who has primary liver disease
WORSENING
priority (ies) • Enzyme found in liver
will guide your • Released into circulation when liver cells are damage.
plan of care? • The liver is responsible for filtering toxins from the blood,
(Management of producing important blood-clotting proteins, and aiding in
Care) digestion and metabolism. Cancer treatment (medications –
3. What MTX) have the potential to damage the liver. Liver function
educational tests determine whether the special proteins that are normally
/discharge found inside the liver cells are damaged and leaking out,
priorities causing elevated serum levels. Trending is necessary to
need to be monitor liver function.
addressed
to promote • Relevant with any patient who has primary liver disease WORSENING
health and • Enzyme found in liver
wellness for
• Released into circulation when liver cells are damaged
this patient
and/or • Has a higher specificity to liver than AST
family?
(Health
Promotion
and
Maintenance
)
What data must be
interpreted as
clinically significant
by the nurse?
(Reduction of Risk
Potential/Physiologic
Adaptation)
What data from the
histories is
RELEVANT and
has clinical
significance to the
nurse?
What assessment
data is RELEVANT
and must be
recognized as
clinically significant
© 2018 Keith Rischer/www.KeithRN.com
, by the nurse?
Ward, J. (2012).
Five
strategies
for a
culturally
competent
patient care.
Retrieved
from
http://www.
nursetogeth
er.com/5-
strategies-
culturally-
competent-
patient-
care#sthash.
BroQf68H.d
puf
Van Leeuwen,
A. & Bladh,
M.L.
(2015).
Davis’s
comprehens
ive
handbook of
laboratory
and
diagnostic
tests with
nursing
implications
. (6th ed.).
Philadelphi
a, PA: F.A.
Davis
Company.
Total Bilirubin: 1.0
Alkaline Phos: 75
© 2018 Keith Rischer/www.KeithRN.com
,ALT: 42
AST: 49
© 2018 Keith Rischer/www.KeithRN.com
, Lactate:1.8 • Remember Krebs cycle and lactic acidosis in A&P due to STABLE
anaerobic metabolism?
• GOLD STANDARD lab to trend with any shock state,
especially sepsis!
• Elevated levels correlate with higher likelihood of dying. For
example, in septic shock, a level >4 reflects a 28 percent
mortality
Lactate builds up within the serum and can be seen as a
marker of strained cellular metabolism
Ionized Calcium: • Represents Ca++ that is metabolically available compared to STABLE
1.05 serum Ca++ that is more generalized
• More accurate determinate of calcium
If low, serum calcium is usually also decreased
Magnesium: 1.9 • Essential to normal cardiac electrical conduction, as is K+
• If too high or low, can predispose to rhythm changes that can STABLE
be life-threatening!
Amylase: 29
• Digestive enzyme breaks down complex carbohydrates
STABLE
• Primarily formed in pancreas and will “leak” into
circulation with pancreatic inflammation
• Relevant with pancreatitis/cholecystitis and obstruction of
• Tonsillectomy at 3 years old under peer relationships to provide security and comfort as they work to gain
general anesthesia. independence from their parents. Children who feel alienated from their
Swanson, K. M. (1991). Empirical peer group may experience depression, impaired social development,
and poor school performance.
development of a middle range theory of
caring. Nursing Research, 40(3), 161–166.
Vallerand, A.H., Sanoski, C.A., & Deglin,
J.H. (2014) Davis’s drug guide for nurses.
(14th ed.). Philadelphia, PA: F.A.
4. State the rationale and expected
outcomes for the medical plan of
care. (Pharm. and Parenteral Therapies)
Sommers, M.S. & Fannin, E. (2015).
Diseases and disorders: A nursing
therapeutic manual. (5th ed.). Philadelphia,
PA:
SKINNY Reasoning
SKINNY Reasoning
school due to her illness and has not been
keeping in touch with her friends.
Clinical Significance:
Rex-Smith, A. (2007).
Something more than
presence. Journal of
Christian Nursing,
24(2), 82–87.
Reviewer
RELEVANT VS Data:
© 2018 Keith Rischer/www.KeithRN.com
