Advice for inactive RN going back to Cardiac with only 1yr Med/Surg experience

Spatialized · Aug 28, 2008

Hello to all fellow Cardiac RN's. I will be starting my new job in a Cardiac/Tele Floor soon. I feel nervous that many people feel I have more under my belt then I do. I have 1yr experience but that was about 4yrs ago. I feel like a new grad all over again. Any advice in what I should be studying would be greatly appreciated.
I am starting on reviewing my cardiac meds but I would like to know how a typical day goes for a Cardiac nurse? What do you see more often? What do you do more pt teaching on? What are the must know things? any info PLZ
thanks

Welcome back!

Sounds like you really will be starting all over again, but it is sort of like riding a bike, it comes back. I would bone up on rhythms, ACLS, standard procedures for your unit (PCI, pacers, EPS?), not to mention getting out your walking shoes. As far as what a typical day is, I know that it is dependent on your floor. Meds & assessments, breakfast and insulins, procedures, tests, admits, discharges, lather, rinse and repeat.

Med-wise, your typicals: beta blockers, ACEIs, diruretics, CCBs, pain meds, antiarrhythmics, ACLS meds, ARBs, the cocktail for CHFers,insulins and oral hypoglycemics, are the ones that come without much thinking.

There are several great resources here on allnurses:

https://allnurses.com/forums/f9/excellent-resources-cardiac-nursing-172090.html

and

https://allnurses.com/forums/f15/helpful-information-ccu-other-critical-care-units-140706.html

plus, www.icufaqs.org

all have great resources for learning/relearning cardiac focus.

The only other thing I can think about, is that the heart is just one system, many of these folks have issues with other systems. Don't get blindered by the cardiovascular side, there may be something else happening.

Best of luck!

Tom

mama_d, BSN, RN · Sep 9, 2008

What Tom said.

We get alot of a-fib pts, CHF, COPD, renal failure (acute and chronic), sickle cell, electrolyte imbalances, real chest pain, not-so-real chest pain.....

As far as must know, learn your floor's protocols for things like chest pain, when to call a near code/rapid response/whatever your facility calls it, get to know which docs to call for what things and what can wait till they come to the floor (or till 0600 if you work nights, our standard time to start calling with stuff). We have standard orders for the ED to use for different diagnoses...if your facility does too, it's a good idea to learn what's on each and when to ignore it. An example...our acute cardiac orders call for NPO after MN, enzymes q8hr x 3, EKG in am, etc. Knowing this, I don't have to check the orders to tell my techs that this is what will be going on. Additionally (the when to ignore it thing) I know that since we don't usually do interventions on weekends, if a patient has three negative sets of enzymes and EKG is stable, no chest pain, I can go ahead and feed them breakfast. It took a while before I was comfortable making those kinds of judgements, and it kinda depends on who the cardiologist is as well.

Oh, and keep in mind that a COPDer who is a CO2 retainer plus a non-rebreather just because they are feeling a little short of breath is a bad idea. Nearly had to code a patient b/c a new nurse freaked out that a frequent flyer's sats were 86%...his baseline was 88%...she put him on a 100% NRB without checking with anyone and shot his PCO2 through the roof. Bought him an ICU bed and a reaming by the pulmonologist.

We have a criteria form that the ED docs are supposed to fill out to make sure that the patient actually qualifies for tele. So far as we've been able to figure out, the only requirement is that at one point in your life you had a heart rhythm...whether it was normal sinus or v-fib matters not.

RN28MD · Sep 9, 2008

Mama and Tom thank you so much for your advice. I will be starting in a couple of wks. There is so much to review. But very excited to start working in a cardiac floor.

Thanks