[gwenith]

I refer to the "no reason for telemetry" patient as "threrapeutic monitoring" we are doing it to make certain staff members feel better.

[Joycean]

We take lido, heparin, insulin (stable with bg q2 hrs), pronestyl, amiodarone, corlopam, natracor, bicarb, cardiazem, dopamine, dobutamine, integrilin, reopro, vassopressin, no nitro...yet. I may have missed some. We do have some patients with elevated cardiac enzymes, usually trending down. venous & arterial sheaths (short term). Post-op carotid endaterectomy, post CCU cardiac surgery, No hemodynamic monitoring. And of course Med/Surg overflow, if we have beds.

[Reabock]

Lately I have been wondering why so many of our pts were on Telemetry, some inappropriately I feel, such as the 96 year old DNR, etcs. My thought is that it is one way to get a bit more revenue from the insurance companies as I know we charge more for a pt to be on Telemetry, and in our rural setting we need every cent we can get.!
I have made my thought known to the Head nurse and she just rolls her eyes at me. But then I'm known for sometimes saying what others may just think.
Just recently we had a LTC pt come in unresponsive, full DNR and was put on tele, DUH!!!!! In spite of me asking to see if ICU nurses were aware of pts DNR status, guess who came rushing out to check on pt when they did the inevitable and died with the monitor recording it all!!!

[Joycean]

Isn't that the worst. No dignity in dying with that situation. I hate to have a DNR dying patient on the monitor! That's almost as bad as a CCU patient with a monitor at bedside and the family focus is on the monitor. YUK

[efiebke]

Originally posted by Joycean
Isn't that the worst. No dignity in dying with that situation. I hate to have a DNR dying patient on the monitor! That's almost as bad as a CCU patient with a monitor at bedside and the family focus is on the monitor. YUK

Yep. It really blows watching a person die . . . even worse watching the person die on a monitor.

Lately. . . I've just turned that stupid monitor off and concentrated on supporting the dying patient and family.



Ted

[mittels]

I worked a tele/step down unit for many years. As far as nitro goes, we titrated as high as it would go. But, we could only titrate for one straight hour. If it required longer titrating than icu/ccu was the place for them to go. We also took care of pt's with many other drips, but if they reached four drips and that included ivf than they were out of our unit. We had many acute mi's on our floor and new positive enzymes. The one thing we did is ship those positives to ICU only if they were anterior wall MI's becuase they usually required closer watching of their BP. You have to remember one thing, we only had 3-4 pt's a piece on the floor of a 36 bed tele/step down unit. If you have well trained staff, this can be down quite effenciantly. We also took care of open heart pt @ 12 hrs post op. If they could sit on the side of the bed then we got them, pacer wires and all.

[caregiver11]

I have found in 14 years of nursing that it depends upon the size of the hospital. For instance I worked at a large hospital with over 300 beds and it is considered one of the leading heart hospitals. We had 4 telemetry units, and we would take lidocain, procainimide, amiodarone, and nitro. We would titrate nitro to chest pain or systolic B/p up to 100 mcg. It was common for us to get troponins that were elevated. Now I am at a community hospital with 219 beds and when I first arrived the progressive care unit could only take nitro if it was less than 10mcg and required not titration. We still take elevated troponins.
Elevated enzymes and nitro can be managed on a telemetry floor if you have heart cath lab available that can provide interventions to prevent further heart damage. The philosphy is: once the vessel is unclogged your risk are significantly reduced.

[Bermuda]

Chest pain....etc, etc...[/quote]

Yes we accept patients with positive cardiac enzynes.. yes we do nitro drips..our max dose is 50mcg/min in our unit...also titled 'stepdown" ...we do dopamine;dobutamine;cardizem;amiodarone;lidocaine; heparin...and take any kind of patient that the Doc orders to be monitored... most in multi-organ failure...isn't that the usual step-down zoo..but I love it.. you hit the floor running everyday...

[Marnaby]

I am a new RN on an intermediate cardiac floor in Mass. We see everything under the sun. We mostly see post cardiac cath patients, but we also have CHFers, and very ill medical patients that they couldn't find a bed for.

As far as drips go, we take Nitro (up to the max of 200mcg), Lasix, Dopamine, Dobutamine, Lidocaine, Amiodarone, Flolan, Procainamide, Milrinone, etc.

Chest pain is common place and we are constantly doing EKG's! It can be a crazy place to work, but I am getting great experience!

[Bermuda]

Yes; most tele/stepdown units are crazy and standard very fast-paced...we do cardioversions;tee's;temporary pacing;post cardiac caths;48 hr post cabg pts;and of course you will have the usual chf;sss;and yes; when you have a very sick medical patient and no where to go then tele gets it...insulin drips and the such....but you are absolutely right... the experience is great and once you have that as your baseline you will be able to work anywhere and your assessment skills will be the best for most all dx...because you see a bit of everything...keep it up and funny but the challenge is what is the turn on for me and I find it rewarding to go home each day and know I learned something new and did the best I could...but also on the other side of the coin burn out....does exist and you either love tele or you don't....some nurses come for a day and we never see them again and sometimes a week and they never come back...but as you say great experience....welcome to nursing.....