Type Of Pts Accepted on Telemetry??

mags-rn · Nov 18, 2003

Here, our telemetry unit doesn't run nitro at all, and it is a rare incidence that they will take a patient with + enzymes, if they haven't been in CCU first. If that patient need to be on nitro, then they should be in a CCU and should be having further testing. It is acutally pretty hard to comment more on this situation without knowing more details.

RNKPCE · Nov 19, 2003

I work Telemetry and we don't take Nitro drips nor does our TCU. We also don't take patients with known positive enzymes on admission, or continuing chest pain or ekg changes. Now this is all in a perfect world .... and we know the world isn't perfect. This doesn't stop the docs from sending a direct admit right to our unit and then enzymes are drawn on admission and whoops........... they are positive. Sometime we do take the ones with troponins in the indeterminate range or patients with atypical chest pain( from doctors we trust won't pull a fast one).

We also get all sorts of wacky reasons why patients needs to be on telemetry. Or patients with no reason at all. Such as a 97 year old no code with a bowel obstructions. When ER staff is questioned why tele there is no cardiac hx nor cardiac symptoms, just the doctor want the pt watched closer. Well we don't watch closer than regular med-surg we are med-surg with tele. As you can see it is one of my pet peeves of working on tele.

TiffyRN, BSN, PhD · Nov 20, 2003

After working 10 years and four different telemetry floors I can tell you this about what types of patients get tele beds. . . All rules go out the door when the bed crunch is on and no amount of protesting about any written or unwritten protocols/standards will help. Also most places I have worked cardiac enzymes were not going to earn someone an admission to the ICU unless the troponin is sky high and even then sometimes the so called stable ones would be sent to us.

As far as drips I haven't seen Nitro drips out of ICU since 6 yrs ago when I was working at my first job in Florida, even then it was only allowed at fixed rates, no titrating. Most of the floors I've worked allow heparin, dobutamine, dopamine (but only at renal doses), cardizem, pronestyl and cordorone.

I did work one tele floor that was very strict about only cardiac patients being there but I think that's because they had so few non-ICU monitored beds (35 beds in a 400 bed facility). I don't remember taking any non-cardiac patients in the 4 months I was there as a traveler.

As far as monitoring patients closer. . . Our patient load was rarely less than the regular med-surg floor only we had patients on cardiac drips that required closer monitoring so how much more attention did our other patients get when we had to be with the the ones on drips so much?

PMHNP10 · Nov 20, 2003

Originally posted by batmik
Or patients with no reason at all. Such as a 97 year old no code with a bowel obstructions. When ER staff is questioned why tele there is no cardiac hx nor cardiac symptoms, just the doctor want the pt watched closer.

My evil first charge nurse used to say of these patients that they are on telemetry so we can watch them die. Who ever said Atilla the Hun has no sense of humor?

LilRedRN1973 · Nov 20, 2003

I need to ask a really stupid question: What exactly is Telemetry? I know what most of the other units in a hospital are, but I can't figure that one out.

PMHNP10 · Nov 20, 2003

Originally posted by RNnTraining1973
I need to ask a really stupid question: What exactly is Telemetry? I know what most of the other units in a hospital are, but I can't figure that one out.

Telemetry is a portable EKG monitor. The sticky pads are attached to the patient like an EKG, and the pads are connected by a wire to a small portable box which shows on a remote screen what heart rhythm/rate is occurring.

Specifically the telemetry unit (aka cardiac unit) usually takes patients who are post open heart surgery (after they get out of the ICU); patients with heart dysrhythmias (irregular heart beats); and other cardiac problems.

JenW · Nov 20, 2003

(Excuse the lack of technical terms in this post, as I'm not yet a nursing student.)

My husband was just admitted to the hospital this past weekend. He was complaining that he was having some kind of pain in his chest. Although it was thought to probably just be a spasm in his esophagus, they admitted him because he's Type 1 diabetic and they wanted to monitor him. We had to sit in the ED from about 6 pm until 1 am to wait for a room to open with the heart monitors. It was kind of strange, 'cause here is this 30-year-old, perfectly healthy-looking young man, hooked up to heart monitors, sharing a room with 2 older men, both of who looked like they were in pretty bad shape.

(He was fine by the way. Again, just a spasm or something in his esophagus. Nothing abnormal ever showed up.)

RNKPCE · Nov 20, 2003

I agree with an earlier post that all rules go out the door when med-surg is full or even TCU which is a higher level of care.

The other unique thing about monitored units is that you get all sorts of code orders.

example: no code cpr but treat arrhythmmias with atropine and lidocaine

no compressions but defibrillation, no being put on ventilator, drugs ok

transcutaneous pacemaker okay, no cpr, defibrillation okay up to 3 shocks, no intubation

no intubation, no defibrillation, drugs okay

the varieties are endless and makes it all the more difficult. On med surg at our hospital you are either a Full Code or a No Code.

And yes as was said earlier sometimes we think we only have No Code patients on the monitor to watch them die.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Nov 24, 2003

Anyone that is a train wreck but doesn't need Critical care...

We take COPD, CHF, Renal Failure, Diabetics, Arrythmias, MI, post Plasty, GI bleeds, Surgicals requiring IV cardiac meds, post CABG, Post Thoracotomy, Chest pain....etc, etc...

gwenith, BSN, RN · Nov 24, 2003

I refer to the "no reason for telemetry" patient as "threrapeutic monitoring" we are doing it to make certain staff members feel better.

Joycean · Dec 6, 2003

We take lido, heparin, insulin (stable with bg q2 hrs), pronestyl, amiodarone, corlopam, natracor, bicarb, cardiazem, dopamine, dobutamine, integrilin, reopro, vassopressin, no nitro...yet. I may have missed some. We do have some patients with elevated cardiac enzymes, usually trending down. venous & arterial sheaths (short term). Post-op carotid endaterectomy, post CCU cardiac surgery, No hemodynamic monitoring. And of course Med/Surg overflow, if we have beds.:roll