Hematocrit (Hct) / Hemoglobin (Hgb) (lab test) abnormal, Anemia

Also Consider:  Abnormal lab test, Shortness of Breath, Weakness (general) 

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

• Thirst, signs of dehydration

• Respiratory: shortness of breath, 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: blood in urine

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

• Skin: sweats (diaphoresis), cold/clammy/pale skin; any new skin condition, i.e., bruising (including potential head trauma), rash

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

  • Below patient’s baseline AND Associated with new hypotension, dizziness, dyspnea, chest pain, or uncontrolled bleeding

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

  • Hct greater than 55
    OR

  • Hct less than 30 AND Hct at least 3 below patient’s baseline. Example: Baseline Hct 25, notify for Hct less than 22

• Notify medical staff on the next business day 

  • Hct at least 3 below the patient’s baseline. Example: Baseline Hct 34, notify for Hct less than 31

• Notify medical staff at the next regular rounds 

  • All other values

4. Implement Management Plan

• Monitor vital signs every 4-8 hrs for 2-3 days

• Offer fluids frequently

• 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 resident representative now and with any changes

2025-04-20