 Welcome to nursing school explain on this playlist where we go into care plan help and help you out with labs that you have to analyze on your care plan. So today's topic is total protein and as we know protein always has to do with oncotic pressure by exerting that pressure on the fluid and keeping the fluid in the intravascular space rather than letting it leak out into the interstitial space so let's keep that in mind. So because of that oncotic pressure we always want to assess patients blood pressure and heart rate because if they are fluid volume depleted or they don't have enough protein in their system that could mean that they are hypotensive because the fluid is seeping out. And then for protein we always want to think about nutritional status because protein is the building blocks of the muscles and the supportive tissues of our bodies. We also want to check the patient's weight which has to do with their nutrition. We want to check their skin for any signs and symptoms of breakdown such as any kind of wounds burns pressure source that you can think of and then we want to check the patient for edema mostly in the lower extremities where that's going to be evident again because of this oncotic pressure and if you have questions I'll put the link of a video below that'll help you remember or go over that oncotic pressure again. And then other labs we want to check is BUN creatinine so anything that has to do with the kidney function as well as the liver function and then albumin which is a specialized protein and I have a separate video about just albumin for this. And BUN creatinine liver function is important here because they always have to do with the breakdown and the excretion of the protein so we want to make sure that if there is too much protein being excreted that the kidneys are not being harmed. So these are the things that we can assess and then for our interventions what can we do so if the patient is hypotensive because of that oncotic pressure maybe we need to give them some IV fluids we can also give the patient albumin which will help to expand the volume but that is a more special case scenario if this is probably more of a chronically ill patient. And before I forget the example that I've been using in these labs was this 45-year-old female status post colosistectomy with the past medical history of diabetes hyperlipidemia and she's a smoker. So now for her if she if we were worried about her oncotic pressure being low in her low protein then we could give her IV fluids like I said or maybe even some albumin. Now if the nutritional status if we assess how much she eats of her diet that she receives so the percentage of the meals as well as her preferences and this particular diet that she's on but for some reason she doesn't like the diet or maybe she hasn't been advanced on her diet after that colosistectomy we could maybe advocate for getting a change in her diet or maybe be a little bit more specific according to her preferences what the food that she likes to eat. And then in terms of the skin we definitely want to provide wound care after that colosistectomy. Now this information here doesn't tell us if it was open or laparoscopic. Most of the surgeries now are laparoscopic but if they are open there would be a pretty large scar and so we definitely would have to provide wound care and make sure that we're not losing protein through that surgical site. And then for if the patient has signs of edema we would want to again change the diet to see if we can give more protein to her preferences into that diet so that we can combat the loss of the protein there and help that oncotic pressure pull the fluid from the interstitial space back into the intravascular space. Thanks for watching this video in the nursing care plan help playlist also check out the other videos about other labs and I'll see you soon right here on nursing school explain thanks for watching.