Telemetry Nursing

Tait, MSN, RN · Nov 7, 2008

Common meds: Cardizem, Coreg, any BP med you can think of, Dijoxin, Coumadin, Heparin, catapress, Natrecor (CHFers), Integrellin (s/p Left Heart Cath), Furosemide, nitro (paste/tab/drips).

Our cardiac floor (well before it became a mixing pot complex med-surg floor due to economic combinations) was primarily left heart caths, stress tests, chest pains, new onset a-fib, exacerbated CHF patients that needed diuresis, pre-open hearts, pacemakers/ICD, etc etc.

The flow is different on days (I work nights) but mostly pts going for procedures and coming back, potentially with femoral cath lines that need to be pulled (we have techs that do it), sending people to 0600 OHS and doing lots of cardiac education.

Be ready for an environment that can change in a heartbeat (pun totally intended). BP's bouncing all over, chest pain coming and going, lots of wonderful heart rhythms, pleasant "walkie-talkies" and painfully uncomfortable men with scrotums the size of watermelons due to fluid retention from CHF.

Also be ready for more diabetic patients then you have ever seen. Diabetes, smoking, high cholesterol, obesity, COPD are among the many complicated histories that come with heart patients.

I adore cardiac nursing and hope we go back to being a more primarily cardiac floor in the future. I love learning about ejections fractions after ECHO's and explaining the mechanism of A-fib (jiggly heart).

As far as techs go, make sure they are adamant about thier vitals/I&O's. You need to know exactly what the HR and BP are for your med passes, and you need to know what is going and coming on that diuresing CHF patient. Otherwise they do all the same things.

Have fun and learn lots!!

Tait

PS. When you start to get engrossed in cardiac rhythm strips remember this: Treat the PATIENT not the RHYTHM. Always lay your hands and eyes on your patient when you suspect a rhythm issue and see if they are tolerating it or not.

mama_d, BSN, RN · Nov 7, 2008

Are you going to be working nights or days? Makes a bit of a difference in the flow...I've done both and prefer nights by far. Tait gave you a lot of good info above.

Learn your drips and the protocols that go with them, along with what can and cannot be titrated on your floor. Learn what can and can't be given IVP on your floor, and what interventions you need to take with specific IVP meds.

As soon as I have my first set of vitals for the shift, I check to see who needs a call to the doc for BP parameters. I also check for code status issues at the beginning of the shift, and who may need an order to titrate down their O2. I try to get all housekeeping calls to docs out of the way within the first couple of hours of my shift.

Be sure to check your charts for orders over the last couple of days. Also, be sure to keep track of who has labs due at odd times (the patients on q6 or q8 trops, the patients on hep gtts, etc.).

Our techs are responsible for EKGs, lab draws, vitals, and fingersticks. I try to make sure that my techs get report from me as soon as possible. Woe to the nurse who waits until 0500 to tell the tech about an EKG, for she will be obtaining said EKG herself! (Unless you have a tech you can buy off with a candy bar....) Keep in mind that the techs plan their shift based on the info they get from the nurses, the better informed you keep them the better they'll be able to help you.

I try to round with the techs whenever I can, so that we can double team them to get care done. Saves immense amounts of time for both of us! Plus, if the vitals are out of whack, I'm there and can assess the patient to determine how symptomatic they are and make the call to give BP meds early, call the doc, etc. without the tech having to track me down.

Also, learn to troubleshoot your monitors. Ours are notorious for overheating when in a gown pocket, which noone in their right mind would ever think of when the monitor states "leads off". It took us forever to figure out that that was the problem! Seems like every kind of monitoring system I've come across has some little glitch that is unique to that system.

I have learned that whether it's days or nights, the more you can do at the beginning of your shift to get organized, the better your shift will run in general. When you first see your patient, pick up the room, bag up soiled linen, make sure Foleys are emptied, make sure I&O are charted, check to see how full IV bags are and whether or not tubing needs to be changed, potty the patient/clean them up, ask them if they have any questions r/t their care or tests you can answer, review allergies with them, check their bands to make sure that they are correct and all present, make sure that pitchers are full (unless they are fluid restricted, in which case, note how much fluid they've had already that day), check to make sure that their IV site looks good and is not outdated. It takes about 10-15 minutes a room, but it saves a lot of time over the course of the shift.

etorres001 · Sep 17, 2010

I am a new Graduated Nurse that just pass my Nclex. I am so exited to start working in the telemetry unit. Thank you guys for sharing this info:)

eyeball · Sep 20, 2010

I just started on a Telemetry unit....Great info in all previous posts! Thank you!

SantinoSLVR · Sep 26, 2010

I'm also a new RN with ZERO experience. I start my orientation this coming Monday for my new Telemetry position. Thanks for all the great info, my friends.