rhythm questions!

[nursingq123]

Hi everyone :)

I just graduated and I am starting a job on a tele floor soon! I have a few questions about the different rhythms and what we are supposed to do in certain situations.

When do we as nurses call the attending if working overnight?

If a patient goes into a fib or vtach would I immediately call a code or a rrt? I have heard conflicting things on this and would love some input.

If a patient has svt what would I do? If they have a heart beat 150?

What if the patient has a high BP that isn't normal for the patient and has a pretty high BP again around 4 am would I call the dr? I would rather call and be a bother than not call and compromise patient safety but I am just curious of these certain scenarios.

I think I am also having trouble figuring out when to call a rapid vs just giving the doctor a call overnight. I know these are random questions and I can use my judgement but I would really appreciate any feedback you could give :)

Thank you!!

[MDMBSNRN]

If a patient goes into any rhythm, and still has a pulse, stay calm and assess the patient first. Check their general appearance, level of consciousness, vital signs, pulse strength, etc. If they are symptomatic, then a call to the doctor is immediately in order. If they are symptomatic to the point of being in grave danger of their life (for instance, if they are in v tach at a rate of 180 with a BP of 60/40) then call an RRT and let the doctor know later. If they are asymptomatic, you may not have to call the doctor at 0300. Monitor them, follow any protocols you have in place, definitely obtain an EKG to document the event, and wait things out a little. If you are ever unsure, check with the other nurses on the floor as more experienced nurses are generally a great resource.

If the patient has symptomatic SVT, then they need to be treated ASAP before it deteriorates. If you have protocols in place for an EKG, oxygen, and Adenosine (or another such drug) follow them. If not, call an RRT if the patient is in grave danger and you cannot wait for the doctor to be reached.

Generally at my hospital if the BP is abnormally elevated, the cause will be investigated, and a PRN medication will be ordered. The MD usually orders a PRN IV push, and says to give it for SBP greater than 165, or whatever parameter they decide on. That way, if it elevates again, you can treat it without calling back, unless the patient displays new symptoms the next time the BP increases.

My policy on RRTs is that they should be called when the patient has the potential to rapidly deteriorate or code within the next few minutes. At my current facility, it may be 20-40 minutes before the doctor calls back. I always think to myself "do I see this patient having another 40 minutes without a negative outcome given their current clinical status?" If the answer is no, it's time for an RRT call.