Creatinine (lab test) elevated

Also Consider:  BUN, Dehydration 

1. Take Vital Signs

• Temperature:

• Blood Pressure lying:

• Blood Pressure standing:

• Heart Rate lying: 

• Heart Rate standing:

• 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. 

  • Creatinine Level higher than the patient’s usual level AND either higher than 3.0 or higher than the patient’s usual level multiplied by 1.5.  For example, if the patient’s usual level is 0.7, then 0.7 multiplied by 1.5 is 1.1.

• Notify medical staff on the next business day 

  • Increased Creatinine compared to the patient’s usual level.

• 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 strict 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

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2025-04-26