Tele Floor

Take a second and breathe. Better? OK. Don't be nervous.

People get so freaked out and stressed out about tele without realizing that we're still nursing. Yes, we have telemetry monitoring, our patients tend to be sicker with more complex issues, but it sill boils down to basic nursing care. Are there things that I would look at to prep? You bet. In no particular order of importance.

1. Rhythms. Get a basic overview. Know what is normal, abnormal, artifact and "oh....". You don't have to be an expert by any means, just fluent enough to understand what is going on physiologically with the basic rhythms. Concentrate on the basics, normal sinus, sinus tach/ brady, atrial fibrillation/flutter and the nasty ones, VTach/VFib & Asystole. Remember, basic overview, you don't have to look at the strip and go, "well it appears to be idiopathic monomorpic wide-complex tachycardia with premature atrial...blah, blah, blah."

2. Typical conditions encountered on a tele floor. CHF, COPD, Diabetes, MIs and ESRD are some of our big ones. Most you should have encountered during med-surg, but a quick review never hurts.

3. Meds. Beta blockers, ACE Inhibitors, diuretics, hypoglycemics, calcium-channel blockers, anti-arrhythmics, nitrates and standard pain meds for your institution.

Jump in a be pro-active. I'm not saying be dangerous or irresponsible, but be active and not a wallflower. Ask questions to further your understanding. For instance I didn't understand why we give D50 and regular insulin to treat hyperkalemia when I was a nursing student, so I asked. Let people know that you're available, to help, to watch and are interested in unique procedures. Soon you'll start having nurses come up to you and say, "Hey come check this out!" especially if you make it known that you want to see everything. I make it a point to do this when I have a student on the floor, even if it seems mundane to me, it may be very cool for them.

I learned these words of wisdom awhile ago: air goes in and out, blood goes round and round, any deviation from this is bad. Words to live by.

If you have any specific questions, or need things narrowed down, PM me and I can try to help. Good luck and have fun!

Tom

Totally agree with Tom. And also, don't let negativity get to you. Nurses and Doctors can have a lot of ego problems. Plus there is a lot of "eat their young" syndrome now. Put it in a bubble and blow it away. Good luck and learn as much as you can! If you try to think in terms of WHY the nurse is picking certain interventions first...i.e. rationale for priority, it will pay off big time come boards. Also try to put pieces of the puzzle together. How does one system affect the other, etc.

Well Tom pretty much hit on all the big points. I've been doing cardiac for 5 years now, and as a baby nurse questions were the first thing I did. It really does help to know you're meds... for example patient was ordered Lopressor and then behind that someone orders Coreg... same class of drugs, they shouldn't get both. Oh, and treat the patient not the monitor. It may say a heart rate of 35, but if they are not symptomatic (sitting in bed watching tv wondering why you are bothering them) are you really going to push atropine? Hmm... let's see... for meds... Lasix is a big one for my unit cause we have a lot of patients with CHF... want to check BP and K+ level prior to giving. Any beta blocker check the heart rate, for us if it's less than 60 we don't give. Oh, and if a patient has a HR of 60 with a pacer, it's okay to give meds that may lower heart rate. Rhythms are fun, ask people for off the wall ones. It's nice to see, and 3rd degree heart block is not a good thing. Like Tom said, tell people you're around, get experience from anything and everything. I was a student when they were doing a cardioversion on the floor once, and the doctor let me hit the button to shock them. It was fun! Not to mention a great learning experience. Hmm... anything else?

I have been a tech on our tele floor and am now an RN on it too. I LOVE tele/cardiac and hate when i go anywhere else when a pt is not on a monitor. I know strip reading can be a hassle at times, but it really is a great experience knowing you can actually see a pts HR drop when giving adenosine or a heart arrhythmia change when on a cardizem drip!