MSK Library Guides: The Memorial Sloan Kettering Cancer Center GERIATRIC PLAN©: Labs

L=Labs

Related Issues:

Electrolyte imbalance, anemia, thrombocytopenia, neutropenia, renal failure, infection, dehydration

Why Labs are Important:

Potential of lab abnormalities caused by age-related physiologic changes
Disease, treatment, medications, and co-morbid conditions can impact metabolic processes
Early manifestations of specific disease entities are recognized in alterations in laboratory values (i.e. anemia, dehydration, malnutrition, or renal insufficiency)
To monitor medication, safety, efficacy and toxicity such as with cardiac (digoxin), and endocrine (thyroid) medications, antibiotics and anticonvulsants

Normal Age-Related Changes:

Diminished resiliency of the immune, renal, hepatic, cardiac, respiratory, and hematologic systems can alter the balance between normal functioning and reserve capacity

Older adults are at increased risk with any of the following:

Conditions

Medication-Related Risk Factors

Diuretics (may potentiate dehydration, hyponatremia, hypokalemia or hyperkalemia)
Anticoagulants (warfarin, Plavix, aspirin)
PPI's can lower magnesium levels
Vitamins and supplements
Polypharmacy
ACE Inhibitors (may potentiate hyperkalemia)
Bisphosphonates (may potentiate renal dysfunction, hypocalcemia)

Behavioral Risk Factors

Chemotherapy-Related Risk Factors

Most cytotoxic chemotherapy agents have the potential to suppress hematologic parameters (Hgb, WBC, Platelets)
Many chemotherapy medications cause nausea, vomiting, diarrhea, mucositis or other symptoms which can potentiate dehydration and cause lab abnormalities
Cisplatin: potential for elevated creatinine, hypomagnesemia
Oxaliplatin: hypomagnesemia, hypocalcemia
Carboplatin: potential for elevated creatinine

Cancer Diagnosis

Surgery-Related Risk Factors

Assessment:

1. Screening Questions

Has anyone ever told you that you have had abnormal lab results? (i.e. anemia, high cholesterol, high/low blood sugar)

2. Observations

3. Screening Tests and Measurements

4. Physical Assessment: Standard physical examination with focus on signs and symptoms of abnormalities

a. Dizziness
b. Muscle cramps
c. Bone pain
d. Palpitations
e. Numbness/tingling
f. Excessive thirst
g. Frequent urination

Nursing Intervention:

Analyze, monitor and trend laboratory values
Coordinate further diagnostic testing and adjust treatment and care plan accordingly
Educate patient and family about potential signs and symptoms related to lab abnormalities
Recognize that correct serum calcium level based is on albumin: Corrected serum calcium = measured serum calcium + 0.8 x 4 - measured serum albumin
Recognize that CKD-EPI equation to calculate glomerular filtration rate offers a more precise formula especially when actual GFR is >60 ml/min per 1.73 m2

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