BUN (lab test) elevated

Also Consider:  Creatinine, Dehydration 

1. Take Vital Signs

• Temperature:

• Blood Pressure lying:

• Blood Pressure standing:

• Heart Rate: 

• Respiratory Rate:

• Oxygen Saturation:

2. Evaluate Symptoms and Signs

• Acute mental status change

• Not eating or drinking as much as usual

• Fainting, dizziness or lightheadedness when standing up

• Acute decline in ADL abilities

• Signs of dehydration

• Respiratory: New cough, abnormal lung sounds, Accessory muscle breathing, pursed lip breathing, Respiratory distress

• Cardiovascular:  Chest pain, new irregular pulse, cyanosis, mottling, edema

• GI: Nausea, vomiting, diarrhea, abdominal distention or tenderness, rebound tenderness, bowel sounds

• GU: New or worsened incontinence, urinary retention / bladder scan

• Neurologic  changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)

• Very low urinary output (<30cc/hr)

• Skin: sweats (diaphoresis), cold/clammy/pale skin; any new skin condition, i.e., bruising, rash, infection/cellulitis

• Fingerstick glucose (patients with diabetes)

3. Take Action using SBAR Report:

• Presence of other, significant symptoms or signs of illness 

  • Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.

• Immediately notify the medical staff & resident representative

  • Panic Level called from lab

• Notify medical staff & resident representative within the next 16 hours. 

  • BUN Level abnormal and higher than the patient’s usual level multiplied by 1.5.  For example, if the patient’s usual level is 20, then 20 multiplied by 1.5 is 30.

• Notify medical staff on the next business day 

  • Increased BUN compared to the patient’s usual level AND the patient is on diuretic medications. 

• Notify medical staff at the next regular rounds 

  • Any other abnormal level 

4. Implement Management Plan

• Monitor vital signs every 8 hrs for 2-3 days

• Offer fluids frequently

• Oral, IV, or subcutaneous fluids if needed for hydration

• Place on Intake & Output monitoring

• Monitor meal acceptance

• Place on 24-hour report for 2-3 days

• Obtain lab results (if ordered), and notify medical as needed of:

  • Significantly abnormal values in lab tests (refer to appropriate Situation)

• Update care plan regarding  fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs

• Review status and plan of care with designated representative with any changes

• Update advance directives if appropriate

2025-04-26