Supposed to teach part of a class where I relate tele to systems - please!!!

[Nurse162]

Please take the time to read, I am open to any ideas/suggestions and would SO appreciate any help.

I am taking over a sub-category of the sub-category that my co-worker teaches as part of a class titled "Nursing Care of the Telemetry Patient." The initial and main part of the class covers: STEMI, cadiac workup, interventional cardiology, cadioversion, what tele is teling you/rhythm strips, and emergenices.

My co-worker speaks about post-operative management of the cardiac patient, something I am extremely familiar with as we receive post-op CABs/AVRs from the SICU frequently on my ward. The part she would like ME to re-do and teach is titled, "Assessment and Nursing Care of Telemetry Patients: Neuro, GI, GU (renal), and Ortho."

My co-worker told me this section was added on for her to teach and she wasn't really sure what to do with it. My understanding is that I must relate telemetry to these body systems. I'm having trouble because the connections she made were not very strong and the set-up is random and not related to telemetry as requested.

I would love some feedback and ideas. For example, for the renal patient I could talk about common electrolyte imbalances in renal failure patients like hyperkalemia, what you would see on your tele monitor (peaked T waves, flat or absent P waves, broad QRS, brady/irregular rhythms, vib if severe), and how you would correct the issue (calcium, bi-carb, insulin/d50, keyexelate).

I'm having trouble with the other sections: neuro, GI, and ortho (and could still use some other ideas for renal patients). For ortho I could talk about co-management of surgical patients who have heart histories and are at risk for dysrhythmias. For example, I once had a standard TKA pt. w/ a heart history on tele that developed asymptomatic sustained SVT. I suppose we could see s/s of infection (tachycardia), fat emboli? I don't know.

Neuro... she talked about stroke patients... yes we may monitor them on tele after a stroke but unless I'm missing something you don't look at your tele monitor and think, "wow that patient might be stroking out right now."

GI... maybe talk about a bleed and hypovolemic shock and what you might see? We have patients in the OR for pro-longed amounts of time that may be placed on tele but even our big GI surgeries don't have orders for it most of the time.

I just don't have many concrete ideas and don't want to make random connections that won't serve the nurses taking this class. Any help is appreciated. Thank you so so so much to anyone that reads this and offers up suggestions.

[LovingLife123]

But think about what you would be watching post stroke. And what can happen post stroke.

We run very tight blood pressure parameters on ischemic and hemorrhagic strokes. We watch temperature very closely too. Increased heart rate and temp can indicate increased cranial pressure which can be very bad. We often need to relieve the pressure by either doing a bone flap or draining the excess fluid. Pupil changes are one of the last signs that something is wrong.

Say you have a GI patient with a bleed. One indication that they are actively bleeding is becoming tachycardia with hypotension.

Telemetry is important in all critical patients as those vital signs are often the first to tell us something is going wrong on the patient.

[Guest219794]

I think you could probably find something for each symptom, but honestly, it's a bit of a stretch. Renal and electrolytes, especially K, as you mentioned. GI- tachycardia as first sign of bleeding (?). You might be able to come up with something for each system, but to what end? Good luck, sounds like a crappy assignment.

A suggestion unrelated to content. Don't read power point slides out loud Ever. Everybody in the room knows how to read.

[Silly_Sally_RN]

For the GI system maybe you could talk about dehydration, prolonged vomiting/diarrhea, nutritional deficiencies, and anorexia/bulemia and how they can lead to electrolyte imbalances which can lead to cardiac issues.

[AceOfHearts<3]

QT prolongation could be mentioned with Zofran (GI) and Seroquel (psych). Those are the 2 main drugs we are concerned about that with.