Help with a patient I have tomorrow on Telemetry

[cminmd]

Tomorrow I have a patient who is on telemetry. This will be my first patient on a cardiac monitor and I was wondering what I need to know. They use a 5 lead system and I think I will have to replace the leads after AM care. Also, what do I need to look for? I am confident I will notice Afib, Vfib, Vtach and G*d forbid- asystole, but what else should I know to look for. Is there something about a u wave indicating a prior heart attach? How do I document telemetry? Do I just include it in my new patient assessment then just document problems? Any advice you could give would be great!!! Thanks!!!:heartbeat

[luvbug080688]

Hmm...I am on a MedSurg floor this semester that has a little bit of everything including tele. The most that we have done with the tele is replace the pads and electrodes (smoke over fire, snow over grass, and brown in the middle), and just look and monitor the tele screen. There are nurses on the floor who monitor if things go screwy and have pagers...so basically I got nothing for you : ( sorry!

[Daytonite, BSN, RN]

replace the leads on the patient one at a time so you know where each electrode goes. there is a short audio tutorial on 5-lead ekg placement here: http://www.m2hnursing.com/ecg_demo/5lead.php. have your sound turned on.

there are weblinks that explain how to read basic ekg arrhythmias on post #39 of this sticky thread: https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites. i worked on a stepdown unit for 5 years and even i can't identify a "u" wave because we never had a patient have a heart attack on us. don't worry about it. a patient's monitor strip is generally run once every 4 hours and diagnosed by his assigned rn and then posted in his chart. they will show you how monitor strips are documented. it involves using calipers and measuring the blocks on the special paper that they use. the strips are mounted in a special section in the patient's chart. ask them how they include the monitor assessment in their charting and who documents it. your instructor may ask you to bring a strip from the patient with you to post conference or include it in your care plan (if you have to write a care plan on this patient), but in most places i worked we never let anyone but a licensed rn or the monitor techs diagnose the monitor strips for legal purposes.