new grad. on tele floor

[ashleighlt]

I am a new grad on a tele floor recently off orientation. I am very nervouse about knowing what actions to take should me pt shows signs of distress and when to call the rapid rispons team. i could use any advice.

thanks

[ParvulusPuella]

You aren't going to be the only nurse on the floor. Keep comminicating with your charge, or other nurses on the floor, and they'll help you think through situations and help figure out if RR should be called or not. They will be your best resource! Good luck! :)

[psu_213, BSN, RN]

There should be facility policies for when to call a RRT. I know when I worked in telemetry they included new onset A fib, SVT, decreased LOC, increased O2 requirements, etc. Check to see if you facility has guidelines and use more experiences nurses if you have a question. Also remember, at the end of the day you are better calling one if you are on the fence about it. Yes, if the doctor sees at as unnecessary, he/she may not be too happy with you, but it's better than doing nothing if your pt is taking a turn for the more unstable.

[turnforthenurse, MSN, NP]

We are to call RR anytime we are worried about the patient or if they make us uncomfortable or if we want a second opinion. Some criteria:

Acute change in HR 130bpm (symptomatic)

Acute change in SBP

Acute change in RR 30 breaths per minute

Acute change in SpO2

Acute change in mental status (delirium, confusion, etc)

Acute significant bleeding

New, repeated or prolonged siezures

Acute change in cardiac rhythm (such as atrial fibrillation with RVR, v-tach, new 2nd or 3rd degree block)

Now this is based on my policy and procedures manual. Your facility may be different.

And as psu stated, it is much better to call than to be on the fence about it.