Mark Klimek NCLEX Review: Lab Values, Five Deadly Ds, Neutropenic Precaution

Mark Klimek NCLEX Review: Lab Values, Five Deadly Ds, Neutropenic Precaution

You will be asked to prioritize different patients based on lab values

Therefore, it is not good enough to simply know the normal/abnormal lab values

You would have to rank or prioritize patients based on abnormally critical lab values

 

Use the “ABCD” scheme to prioritize patient based on lab values

- Low priority

   - A is low priority … This lab result can be ignored for a few hours or, if late at night, until very early morning

   - B is concerning … This lab result needs to be closely monitored

- High priority

   - C is critical … You need to do something for this lab

   - D is highest priority … Stay at the bedside

 

The RN does the first set of assessments for Levels C or D … Example: V/S, lung and heart auscultations, abdominal exam, etc.

 

Neutropenic Precautions

- Strict hand washing

- Vital q4 hrs

- Dedicated stethoscope, BP cuff

- Reverse/protective isolation

- Shower BID with microbial soap

- Avoid crowds

- Private room

- Limit staff/visitors

- No fresh flowers/potted plants

- No raw fruits/veggies/undercooked meat

- No water pitcher standing for over 15 minutes

- Check WBC daily

- No indwelling catheters

- Do not reuse cups or disposable plates

Five Deadly “Ds”

- The following are 5 priority pts based on their lab values

- The NCLEX exam will not put one of the followings against another

- K+             >6

- pH            in the 6s

- CO2          in the 60s

- pO2          <60

- Platelets   <40,000