Lab and Components Flashcards
What are the 4 priority levels for Lab orders?
- Routine
- Timed
- Urgent
- STAT
routine priority level
The majority of bloodwork for inpatients is handled with the routine priority, laboratory staff monitor all requests and collect on routine rounds, routine orders after 1400 should be dated T +1 for next day collection.
timed priority level
For drug levels i.e. Trough and peak levels, order under separate entries in OE to establish actual collection time for both levels to be collected. Enter accurate times for the start and finish of the medication each time you enter orders.
urgent priority level
Urgent blood work orders are monitoring my lab stuff ASAP. Continue to follow as usual for urgent collection.
STAT
situations only. For example, in the case of an emergency C-section. Continue to phone/page the lab as usual for STAT collections.
APTT
activated partial thromboplastin time
What tests are APTT / PTT?
Coagulation studies. Performed individually and are commonly used to monitor heparin dosage
PTT
partial thromboplastin time
PT
prothrombin time
INR
international normalized ratio
What tests are PT / INR?
Tests that measures the clotting ability of the blood. The test assists the doctor in determining the dosage of anticoagulants prescribed
thrombin time
May be performed to monitor heparin therapy
fibrinogen
This test helps to evaluate how well the blood clots
FDP
fibrin degradation products
FSP
fibrin split products
What tests are FDP / FSP?
Tests that evaluate any abnormalities in the clotting of the blood.
What are you to indicate on the lab requisition if the doctor orders “coagulation studies”?
INR and PTT
What is daily bloodwork?
Daily bloodwork is any bloodwork that has been ordered and is to be done on an ongoing basis for a length of time determined by the Physician.
Examples:
- CBC, INR daily
- Lytes q 2 days
- INR Q Wed & Sat
- CBC STAT, then daily
When is daily bloodwork collected?
Routinely at 0700 every morning until D/C’d
Where is daily bloodwork recorded?
On the Kardex with the dates of the specimen(s) to be drawn.
Also to be recorded on a unit Daily Bloodwork Card
What do you symbolize on the PO for daily bloodwork?
- K
- RMO
- I/C
What is the Daily Bloodwork Card or Diagnostic Test Card?
A non-legal document used by the staff for daily bloodwork that is to be drawn for 3 or more days.
What information is needed to fill out the Daily Bloodwork Card or Diagnostic Test Card?
- Room and bed number
- Patient’s name
- Tests
- Freq. / Date
How are you to transcribe the patient’s name onto the Daily Bloodwork Card or Diagnostic Test Card?
LAST NAME, First name
How do you transcribe the tests onto the Daily Bloodwork Card or Diagnostic Test Card?
As they are written by the doctor
What do you write under Freq. / Date on the Daily Bloodwork Card or Diagnostic Test Card?
The date the tests are to be completed.
Example:
16, 17, 18
What do you do when the bloodwork has been drawn on the dates requested?
Cross out the date once completed
When is an add on lab test ordered?
Routine to be used if blood work has already been collected/drawn on a patient for the day and there has not been a change in the patient’s
condition which may require a new collection (onset of chest pain/SOB).
What lab tests applies to the add on procedure?
- hematology
- chemistry
- coagulation testing
What lab tests are not included in the add on procedure?
Microbiology or TML (Blood Bank)
What are the 6 steps of the add on lab test procedure?
- Check Kardex/PO for previous orders to see if patient has had Bloodwork drawn already for current day and which tests were done and if you can add on new bloodwork being ordered (some sites use order entry for this routine and do not call the lab unless urgent or stat)
- Call the lab and advise which lab test needs to be added onto previous blood work drawn if same category/tube – include pt name/room & bed #, Unit #, PHN & birthdate prn
- Kardex the order in the lab section (note that this is an add on)
- Symbolize on PO – Dept aware and K
- Stuff chart prn
- Flag chart for RN
What is another name for CBC?
automated panel
What tests are automatically included in a CBC?
- Hgb
- Hct
- WBC
- RBC
- Diff
- Platelets
What are the 10 steps of the coagulation checklist?
- Scan the Physicians order and previous order
- Fax order to Pharmacy if there are meds
- Check and double check patient’s name
- Transcribe the order onto the Kardex. Symbolize the PO - K
- Complete the requisition from the Physician’s order and include the following:
- Addressograph / label
- room and bed #
- date to be done
- time to be done
- diagnosis
- ordered by
- test name
- any miscellaneous information prn
- is pt. on anticoagulants – yes/no
- is pt. on heparin – yes/no
- if pt is taking warfarin tick off the box and transcribe the warfarin order on the line provided
- tick off appropriate test with S or R
- use the blank line or Other Tests area of the req. for those tests that are not listed
- Symbolize the PO – RMO
- If it is a STAT order call the Lab. Symbolize the PO – Dept Aware. STAT coagulation orders are not transcribed to the Kardex.
- Fax requisition to Lab. Fax stamp the req. and include date and time.
- Sign Off
- Stuff chart prn
- Flag chart for RN
LMWH
low molecular weight heparin
What is LMWH?
Class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis.
What are 4 common LMWH medications?
- dalteparin - Fragmin
- enoxaparin - Lovenox
- fraxiparin - Nadroparin
- tinzaparin - Logiparin
