TachyBrady

Thank you mydesygn. I will find out which version of Meditech we have. We have the basic generic patient list that has name, room number age, doctor, diagnosis, etc etc that prints out as a list. Is that the PCS patient profile report? We use that as our "brain" to write our particulars of each patient. What does it mean to "write" an NPR report? Once it is written will it need maintanance? What is the 'end-of-shift report' in the process interventions that was referred to Sun0408?? What we need is very basic! I can't believe that something like kardex information is so difficult to incorporate into our system. It would be nice to visualize these suggestions. I will be meeting with IS this week and want to be as prepared as possible as to what is available. Otherwise, they will just tell me "it's not possible" and we will be back to square one. Thanks for your help.

That MeditechL message board is a little too deep for me. Any other suggestions for where I may find Meditech process intervention info including ekardex and/or end of shift report info?

What is PCM?

p.s. I have many more Meditech questions if anyone can help me out. Thanks in advance.

Thank you. this sounds exactly like what we need!! But we don't have it in our process interventions. How do we get it there? Is there any way I could see an example of it?

I was wondering if anyone could help me figure out the best way to develop a kardex in Meditech. We recently got rid of our paper kardexes and IS developed an ekardex that pulls info from iatrics (not sure if I am using and/or spelling the right terms). The result was disasterous, taking way too much time to load and search for this very basic and needed patient info. My UM is putting together a new team to develop a kardex that is quicker and easier to access. We all want the paper kardex back but I don't think that is going to happen. Can you give me any advice or point me in the right direction to learn more about the available options in Meditech? We will eventually meet with our IS people but they are not very open to our ideas or suggestions... it's either their way or no way. Obviously their original way was not very practical! Thanks for any help you can give me!

Is that like giving oxyincontinent... ?

Health IT should: "• enhance workflow, perhaps by automating mundane tasks or streamlining work, without increasing physical or cognitive workloads" I don't think this is happening at my facility!! They are always adding more and more computer documentation screens and it bogs down the work flow. Is there anyway to visualize and compare health IT products? Surely there is a better way to document.

yep Mort, pick B

This actually is a good question. The answer is D and the reasoning is that people that have CHF should be closely watching their sodium intake. A normal person eats a 4 gm sodium diet. Someone with CHF should eat 2 gms a day. A college student probably eats 6 gms or more a day. A chronic CHFer will take a diuretic and closely watch their sodium intake. All it takes is a Thanksgiving dinner with loads of ham and all the processed fixins, Christmas dinner, a birthday party, cookout, etc., to push the sodium intake over the edge. Sodium retains water. Sprinkle some on your counter or eat a bag of chips yourself and see if it aint so. As nurses, you should be aware of the sodium content in foods. Read labels. Processed meats, canned foods, snacks.... all a big no-no. A 'Holiday Heart' is similar... binging on drugs, alcholol, or sodium, can throw a monkey wrench into the works. I've been a telemetry nurse for 17 years. We gear up for after-holiday admissions... SOB and CHFers being the big ones. The quick fix is easy.... IV lasix. The long term management requires sodium reduction and PO diuretics. If you think a little pickle or slice of pepperoni pizza won't hurt, think again.

Your department sounds too management heavy. Two unit managers and one charge nurse, none of which take patient assignments, is a waste of bodies. We are a 30 bed tele unit that shares a unit manager with another department plus our charge nurses take a full patient assignment. I doubt your immediate superiors will appreciate a suggestion to decrease number of management and increase pt-care staff but it definetly sounds like your facility could use some restructuring.

This actually is a VERY good learning tool for dysrhythmias..... the doctor's arms are the atria and his legs are the ventricles. His antics illustrate the conduction! A must-see for students! Thanks for posting this.

excuse me?

hope this helps.

I have to disagree on a couple of points here..... many patients live perfectly well with a BP in the 90s and some even in the 80s. The reason these patients' pressures are so low is because they take a beta blocker daily. Lowering heart rate and BP are expected and desired effects and result in easing the work of the heart. Coinciding considerations are whether the patient is symptomatic and whether this HR and BP are their norm. Rebound tachycardia can occur in patients who do not recieve, for whatever reason, their normal beta blocker dose. Be careful to not cause more problems with your good intentions. What other drugs (other than dig) lower HR with out lowering BP? I dont' think I've ever seen a normotensive patient bottom out simply from a dose of lopressor or other beta blocker. Perhaps there was something else going on in the patients you mention? Lopressor is the trade name for metoprolol, a beta blocker. In its original studies, lopressor was proven to lower blood pressure as well as benefit angina and MI patients. I'm not sure what year lopressor came out but much research has been done since then. Beta blockers, including metoprolol, are now indicated for rate control for certain rhythms as well as is the first line treatment for acute MIs and angina. Many of our patients are ordered "lopressor" for rate control. Of course our pharmacy substitutes metoprolol.... in the end it's all the same. Sometimes you have to think outside of the box. Last but not least, who do you report your doctors to when you don't agree with their treatments?

While I don't recall any one specific scenario such as you describe I can guess at the MD's reasoning: 1. correct the underlying cause of dehydration and decreased HR will follow 2. by lowering an excessively high HR, cardiac output will increase If you were concerned about dropping her pressure further, why did you give the diltiazem? It sounds like the MD and NP were tackling the problem from 2 different perspectives. Which one is right? Who knows but it is confusing and unsettling to have both of them giving conflicting orders. They should have conferred and mutually agreed on one course of action FIRST. It is not uncommon to have several chiefs stirring the pot and each one having a different opinion. Does that mean that one is right and the rest are wrong? No, it just means they are taking different approaches. If plan A doesnt work, then go to plan B or C or D.

With all due respect, as a floor nurse, I am ultimately responsible for my care of a patient. My nursing assessments ARE NOT done for the benefit of the PCP but rather document the pt's condition for the medical record and also provide a baseline used for tracking changes in condition. Nursing assessments are passed on from shift to shift in order to detect changes and ensure continuity of care. To state that "the physicians are still the minds" is demeaning and false. I am my own eyes and ears and mind. I am completely responsible for my nursing care of my patients. I will notify the PCP with issues that concern medical treatment; otherwise, my nursing practice is dictated by MY education and experience (not the doctor's!!!). At my place of work, physicians are appreciative and respectful of nursing's independent assessments, interventions, and judgement when they need addressing. Nursing diagnoses are a whole different can of worms!

Wow, sounds like a scary situation for you but it also sounds like you handled it very well. In my opinion, this patient should have been started on a beta blocker and an antianxiety med before leaving the ER. Enzymes, thyroid, echo, and stress test will rule out any physical/physiological causes for the panic attacks. Which came first, the chicken or the egg? Is it primarily a panic attack increasing the HR or is there some underlying abnormality that is causing the panic attack that is thereby causing the HR to go up? I had a pt once that was discharged, dressed and ready to go home when he suffered a panic attack with feelings of doom and increased HR. EKG showed he was infarcting right then and there!! I've also had pts that the cause was purely psychological. My advice... in situations where you are unsure (and yes you will always have these situations no matter how many years of experience you have), always get help. Get coworkers, charge nurse, supervisor, doctor, rapid response team, code team, etc etc.

Sounds awefully fishy to me. Unless this girl and her parents have some sort of religeous or cultural beliefs that prohibit surgical intervention, I can't imagine any physician allowing periods of asystole and symptomatic bradycardia to go untreated. A pacemaker is indicated. And I agree with deeDawn that doctors would not allow this woman to drive with untreated syncopal episodes regardless of the cause. Maybe she meant that her heart rate dropped to 40 bts/min instead of stopping for 40 seconds? If that is the case and she is symptomatic, a pacermaker is still indicated. If anything, I think "icing" oneself would cause a vagal response and slow the heartrate initially (not increase it). Do you not require complete medical histories, illnesses, conditions, etc on employees? You need more accurate info from this woman.

Is there any reason why we can't discuss it again with new ideas and input? To the OP... sorry for your bad experiences. Just remember that not all nurses or departments or facilities, for that matter, treat students as you've been treated. It is a shame. I don't know that there is anything you can do in these bad situations other than gathering what experience you can and remembering how frustrating it is for students once you become a practicing nurse. Good luck.

The majority of flutter rhythms I've seen have been controlled (ventricular rate less than 100). However, there is the occasional rhythm that Dinith mentioned that appears to be a sinus tach but in reality is a 2:1 flutter. The T wave is really a second P wave or the P wave is buried in the T wave. The ventricular rate is around 150. If you have what looks like 2 P waves for every QRS, i.e. 2:1 conduction, and a ventricular rate of less than 100, you know that it cannot be an atrial flutter because the atrial rate in atrial flutter HAS to be 280 to 320 (some sources vary on the actual range but you are safe to say an average rate of 300 beats per minute). If the ventricular rate is 80 and there are 2 P waves for every QRS, you would times 80 by 2 to equal an atrial rate of 160. This cannot be because the atrial rate in flutter is always around 300. This is a complicated concept but it can be helpful in rhythm determination.

I agree. The atrial rate in atrial flutter is always between 280 and 320. Therefore the ventricular rate will depend on the rate of conduction, i.e. 2:1, 3:1, 4:1 etc. The ventricular rate will be a multiple of the atrial rate. For example, if you have an atrial rate of 300 with a 3:1 conduction, the ventricular rate will be around 100. In 2:1 condution, the ventricular rate will higher (150) and in 4:1 condution, the rate will be lower (70-80).

What I would have done in this situation is to inform the receiving nurse during my report to him/her that the pt was not given the oxycodone. I would ask their opinion as to whether it should be given and offer to give it before signing off on the pt's care if that nurse so requested. It sounds like the receiving nurse was on an ego rant and that is sad. How is one to know what is best? You did a good job in monitoring the pt and reporting abnormals. In the future, don't hesitate to ask the receiving unit how care should be handled... two heads are better than one and that is their specialty. When you offer respect for their experience and knowledge, they should return respect to you for doing the best you could under the circumstances.

You could have held the cardizem for a trial of the amiodorone since the cardizem wasn't working anyway. In an emergent situation like that, what have you got to lose? I agree though that once the cause is corrected, the HR hopefully will normalize on its own.

Serial Troponins