New nurse on cardiac tele

[momsspaghetti]

Hello all! I graduated from nursing school this past spring and started working as an RN in August. I'm in a program that rotates through different floors in our hospital for about 2 months at a time. Starting tomorrow, I will be going to a cardiac tele floor. I feel like all through nursing school cardiac was my weak spot. I will only have 2 weeks with a preceptor as I already had my longer new RN orientation on my previous floor. On the floor I was on (neuro) I had been off orientation for 3 weeks and nobody died so I guess I'm doing OK but I'm still so very nervous! If anyone has any tips or tricks specifically for cardiac tele or just for new nurses in general I would appreciate it! I will be on night shift if it makes a difference.

I do have a specific question if anyone feels inclined to answer: If there are no parameters in the order, was BP and HR would you hold a beta blocker for? A couple days ago I had a pt on atenolol whose HR was staying in the 50s and 60s and a slightly lowish but WNL BP. I asked an experienced RN and she said she never holds beta blockers except when the pt is going into surgery. So I gave the atenolol and his HR stayed around the same. Yesterday I had a different pt whose HR was hovering around 100 or a little above but her BP was in the 80-90/50-60 range (she was asymptomatic). She had metoprolol scheduled but I saw that it had been held a couple times by nurses on the previous shift. I rechecked her BP a couple times, and notified the MD. When an MD came in shortly after (wasn't the same one, seems like there are atleast MDs onboard for each pt) I let her know about the BP and that I would be holding the metoprolol. She seemed to concur. So I guess I'm just asking what parameters you would give a BB for and if I was right in these situations. I would have felt very uncomfortable giving a BB for a BP that low.

Thanks for any help or advice!! :)

[Rose_Queen, BSN, MSN, RN]

I'm not a cardiac tele nurse, so I don't have any tips for you. However, just because the order doesn't specify parameters doesn't mean you don't have any. Unless an ordering provider specifies otherwise, my facility has a policy regarding when BB should be held- HR

[Mavrick, BSN, RN]

This is an incomplete order. Good on you for catching it but ..... If you are concerned enough about holding a medication to call the provider, get the order clarified. Not just for yourself but obtain a written clarification for all the nurses giving medication for this patient. A physician "seeming to concur" is not an order and by failing to clarify the order when talking with the physician you have left it for someone else to do. No one appreciates a slacker. Especially night nurses that get stuck making very inconvenient phone calls at very inconvenient times to deal with things that could (and should) have been dealt with on day shift.

There are certain "target" numbers that will make you think twice about giving a medication (i.e. HR

[HouTx, BSN, MSN, EdD]

Always check for facility policies first. If there isn't one, request specific dosing parameters from the physician. Be sure to also educate the patient/family about this also because lack of accurate medication information = unplanned readmission. Don't try to second guess the physician's order. According to most Nurse Practice Acts, this is essentially practicing medicine; a violation of your license. Don't go down that road, even if it seems like 'common sense'. If anything goes wrong, you'll end up under the bus.