Help me survive tele floor, pls!!!

nurse2033, MSN, RN · Sep 24, 2011

You should be looking for trends, like increasing PVCs, longer pauses, more runs of Vtach, widening QRS, ST changes. A skipped beat? who cares? but if it continues or gets worse... Sick hearts do all sorts of interesting things all the time. Obviously document anything concerning like a long pause, or multiple runs of Vtach. You are doing the right thing by checking your patient. Keep going...

FancypantsRN · Sep 24, 2011

One pointer is to consider what will be ordered by the doc if you call him. If nothing, then I would probably not call in the middle of the night for it (example: trigeminy or a couple of PVC's). I would find out your policy on runs of vtach. The tele floors I have worked on stipulated to call for "x" amount of beats for orders. I always printed out a questionable strip and noted the pt BP and symptomatic vs nonsymptomatic and flagged it in the progress notes. Also, don't be afraid to ask your charge nurse for advice if you are not sure.

nursej22, MSN, RN · Sep 24, 2011

Kudos for checking your patient. This is always the #1 thing our docs will ask if we call with an arrhythmia. You probably don't need to tell your techs every time you check your patient, but do give them some parameters so they don't have to call for every pause. Ask them to notify you for increasing trends, longer, more pauses, increasing PVCs, HR if you titrating dilt.

And HR

Pauses in and of themselves are not something to call for. What is causing the pause may be:

Is the patient in Afib in the 60s and having pauses? They may need a decrease in meds they are getting for HR control.

Are they having non-conducted PACs? Not much you can do other than check oxygenation and electrolytes.

HB? Sinus arrest or exit block? This is something to call about.

Our policy to post an example of each arrhythmia once a shift. Our techs do that. If we get particularly unusual strip, we may leave in on the chart for the MD to see.

casi, ASN, RN · Sep 24, 2011

When I worked as a tele tech I loved the nurses who gave me parameters for certain patients. If the patient is having hourly 8 beat runs of v-tach a nurse would tell me "Call me if it's longer than 10 beats of occurs more frequently.

It also never hurts to throw a strip in the chart with a quick assessment.

Biffbradford · Sep 24, 2011

If they start having lots of unusual ectopy, then you might want to check their latest labs. Make sure they don't have a K+ of 3.0 or Mg++ of 1.5 or something, but nobody noticed it yet.

NewTexasRN · Sep 24, 2011

I definitely think you are on the right path like the others said. Just remember that you are not alone. With time and experience you will get better at making these judgement calls. If you want to be more proactive about your education, I would suggest taking an EKG course or studying one of those book. There are so much material out there. Some of them are free. I would also suggest taking ACLS. That really broaden my knowledge on recognizing lethal rhythms and what kind of interventions to expect. I still struggle with it too. Just keep working at it. I believe the techs in the monitor room are great, but I would like to know for myself. I always thought that if they missed something, it's still on you because you are the nurse taking care of that pt. Lastly, on time a had a pt with an arrhythmia, I documented when it happen, what type of rhythm it was and that the pt was asymptomatic. I even informed the MD on call who happened to be there on the floor that night. Well, did you know that the primary MD came in and asked for a print out. Honestly, I didn't know that it was the hospital's policy. So the charge nurse called me and had me standing there in front the MD to explain why I didn't print the strip. I guess I learned my lesson after that.

SkylerW · Sep 25, 2011

I would call telemetry so they can note the BP ( its a requirement at my hospital)

Jenni811, RN · Sep 25, 2011

i ALWAYS call the doctor when i get a call from telemtry....always.

It is actually our hospital policy to page the doc with any call from telemtrey (other than leads off or battery change etc.). Then i write a note in the note section stating that i was notified, what they stated, what time they called, what the patients rhythm was, if they are symptomatic, vital signs and which MD i paged and at what time i paged.

Document, document, document. If you didn't document it, it didn't happen.

i got a patient with a pacemaker, and call from telemetry that patient was inappropriately pacing. Now if i would have not notified the doctor of this, would they have sent this patient home with a pacemaker that wasnt functioning correctly?? I paged the MD and documented everything.

DookieMeisterRN · Sep 25, 2011

I'm new RN grad working on busy med-surg/tele floor. I have always wanted to be a nurse and I like what I do although, sometimes, I feel like running away from my floow when it's really busy.
I just need some pointers on what to do or how to handle telemetry calls. When they call and say this pt has "2-second pause" or "HR dropped to 50" blah blah blah...I always go and check on my patient, make sure their not symptomatic. Do I always have to print a strip when they call and document it? Do I always go and tell the doctor? Should I call the techs back and tell them the pt is ok?
I know I have to notify the doctor when they are symptomatic. But, I just want to make sure I'm doing the right thing.
Would you please tell me what you usually do or what you do when tele calls and say pt has bigeminy or such? What kind of rhythms should I really be concerned for aside from VTach, VFib, Asystole???
Thank you.

What does your preceptor suggest? What does your charge nurse say you should do in specific situations? I'm not trying to sound harsh but the answers you receive may not be your hospital protocol. It also depends on your patient and their specific history. I'd hate to see you be misinformed and not be in accordance with your protocols. I don't think it's wrong to ask questions here on this forum but you really need to become aquainted with your hospital policy and procedure as they can vary greatly between facilities. If you're on a unit with monitored beds you should have taken a EKG class (and that will provide you with a lot of these answers) before you can take care of tele patients?

Catherine_RN · Sep 25, 2011

Thanks for the replies. I appreciate it. Being a new RN can be overwhelming and intimidating. I'm doing my best and every day is a good learning experience on the med-surg floor.

@ DookieMeister,RN.... I understand what you're saying. I would definitely take the time and look at the policies. I just wanted some input on how seasoned nurses handle these situations.

DookieMeisterRN · Sep 25, 2011

Thanks for the replies. I appreciate it. Being a new RN can be overwhelming and intimidating. I'm doing my best and every day is a good learning experience on the med-surg floor.
@ DookieMeister,RN.... I understand what you're saying. I would definitely take the time and look at the policies. I just wanted some input on how seasoned nurses handle these situations.

I know the 1st year or 2 are very overwhelming especially when on a tele floor, good luck it will get easier :-)