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2 Minute EBP Challenge

Monday, July 26, 2010
Ms. Shepard and DIC
This morning rapid response is called for Ms. Shepard who was admitted with a urinary tract infection and sepsis. Her blood pressure dropped during the evening hours and she is now hypotensive and is having difficulty breathing. Her IV sites are oozing and there is blood in the urinary catheter. Her physician suspects disseminated intravascular coagulation (DIC). The primary mechanism in the development of DIC is:

Monday, July 19, 2010
Thyrotoxicosis

Which of the following laboratory findings is indicative of thyrotoxicosis?

Monday, July 12, 2010
Urban CPR Patterns
In a recent study of inner-city neighborhoods, the authors found that out of hospital cardiac arrest was 2-3 times higher in some neighborhoods compared to others. In these high incidence neighborhoods what was the rate of bystander CPR?

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Home > 2 Minute EBP Challenge > GI Bleeding Labs

GI Bleeding Labs

Monday, October 26, 2009

Stay up-to-date the easy way!

How would you answer this question?

Lab values suspicious of gastrointestinal bleeding include:

a. Increased BUN, increased creatinine
b. Decreased BUN, increased RBC count
c. Increased BUN, decreased HCT
d. Decreased HCT, decreased Hb

The correct answer is "c," increased BUN, decreased HCT.

A decrease in the hematocrit associated with an increase with BUN signals gastrointestinal bleeding.  Look for concomitant non-steroidal anti-inflammatory (NSAID) use.  Anemia is a common problem in our hospitalized patients.  However, one way to help differentiate the etiology of anemia is to take a look at the patient’s BUN.  The blood urea nitrogen (BUN) will increase and hematocrit will decrease if your patient has gastrointestinal bleeding.  Dehydration can also increase the BUN; but with dehydration you will see an increase in hematocrit, not a decrease.
 
What happens is when the patient has GI bleeding the blood is digested and proteins from the blood get back into the bloodstream in the form of urea nitrogen.  By assessing the BUN together and independent of creatinine you will be able to differentiate between renal problems, dehydration and gastrointestinal bleeding.
 
 
Here is how to use it in your practice.  A drop in hematocrit with no change in BUN indicates that the patient is bleeding elsewhere, maybe from a wound site.  A drop in hematocrit associated with an increase in BUN indicates gastrointestinal bleeding.  An increase in BUN and an increase in hematocrit indicates dehydration.
 

 

HCT  

BUN  

GI Bleed  

Dec.

Inc.  

Dehydration  

  Inc.

­­ Inc.

Hemorrhage  

Dec.  

Norm.  


Congratulations to Roni Kozlowski who won an autographed copy of my101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Roni!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

PS. This week's question came from our Expert Assessment program.

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