Exam 1: EKGs
Terms in this set (22)
ACUTE INTERPRETATION OF AN ECG DEPENDS ON THE CORRECT PLACEMENT OF THE LEADS ON THE PATIENT. AND THE MONITORING LEADS THAT GET SELECTED DEPEND ON THE PATIENT'S CLINICAL STATUS.
acute interpretation of an EKG depends on?
This provides a record of the patient's rhythm. It also allows for measurement of complexes and intervals, and for assessment of dysrhythmias.
What can an ECG rhythm strip tell us about a patient?
Property 1 = Automaticity: Cells are able to initiate an impulse spontaneously and continuously
Property 2 = Excitability: Cells ability to be electrically stimulated
Property 3 = Conductivity: Cells ability to transmit an impulse along a membrane in an orderly manner
Property 4 = Contractility: Cells ability to respond mechanically to an impulse
There's 4 properties of heart cells that allow the conduction system to: start an electrical impulse, send it through the heart tissue, and stimulate muscle contraction **
each small square = 0.04 seconds
each large box equals 0.2 seconds. (0.4 x 5 small boxes = 0.20)
300 large squares then equal 1 minute
ECG paper: consists of large/heavy lines and small/light squares.
each large box contains 25 small squares- 5 horizontally and 5 vertically.
each small square horizontally represents how many seconds?
How many seconds is each large box then?
How many large squares add up to 1 minute?
Count the number of R-R intervals in 6 seconds, then multiply that number by 10.
Below 60 is bradycardia.
Above 100 is tachycardia.
normal HR should be 60-100.
* this way gives you the estimated number of beats per minute.
How do you count the HR on an ECG strip?
Artifact is an interference; it's a distortion of the baseline and waveforms seen on the ECG.
when leads and electrodes are not secure, if the conductive gel is becoming dry, and if there is pt muscle activity like tremors or shivering, or if there is electrical interference you will see artifact on the monitor (wont be a straight line).
-accurate interpretation of the heart rhythm is difficult when artifact is present. Find the cause and fix it. Ex: clip the patient's hair back, dry them off, check the connections in the equipment, replace the electrodes if the conductive gel has dried out.
what is an artifact and what can cause it
Monitoring is great bc early detection of abnormal heart rhythms allows you time to assess the patient for signs of hemodynamic instability - like chest pain, hypotension, palpitations, dyspnea, and therefore determine the need to intervene - like calling the RRT.
BUT THESE ARE STILL COMPUTERS, SO THEY'RE NOT FAIL PROOF. Frequently assess all monitored patients for any signs of hemodynamic instability.
ECG monitoring can be wireless, centrally continuous, or one that doesn't require constant surveillance.
why is this beneficial to the nurse?
refers to a rhythm that started in the sinus node/SA node, at a rate of 60-100 times per minute; and the impulse follows the normal conduction pathway.
describe a normal sinus rhythm
Check the patient's hemodynamic status - do they have hypotension, chest pain, palpitations, dyspnea?
^ These responses will guide the interventions you select.
-and determine the cause of the dysrhythmia!
when assessing the heart rhythm, make an accurate interpretation and immediately assess the patient's clinical status. When there is ANY change in a patient's heart rhythm, what must the nurse do?
it can help rapidly ID dysrhythmias, ischemia, or infarction
Why is telemetry monitoring useful?
-disorders of impulse formation
-disorders of the conduction of impulses
- normally the SA node is the pacemaker of the heart and it spontaneously fires 60-100 times per minute. But secondary pacemakers in some cases may fire more rapidly than the SA node, or the SA node may be slower than the secondary pacemakers.
dysrhythmias can result from either...
when a secondary pacemaker fires the impulse - the normal sinus rhythm is replaced.
Dysrhythmias occur as the result of various abnormalities and disease states. The CAUSE of a dysrhythmia influences the patient's treatment. WE TREAT THE CAUSE!
what is a dysrhythmia
excitability - this is an important part of the transmission of the impulse from one cell to another.
* the level of excitability is determined by the length of time after depolarization that the tissues can be re-stimulated. Then the recovery period after stimulation is the refractory phase or period.
The impulse started by the SA node or from an ectopic focus must be conducted to the entire heart. The property of myocardial tissue that allows it to be depolarized by a stimulus is called ?
Electrophysiologic study EPS
event monitoring/loop recorder
exercise treadmill testing
_ can be performed on inpatient or outpatient basis
What other tests can we use to assess dysrhythmias during hospitalization ?
can identify the causes of heart blocks, tachydysrhythmias, bradydysrhythmias, and syncope. An EPS study can also locate accessory pathways and determine the effectiveness of antidysrhythmic drugs.
Explain what an electrophsyiologic study EPS can do
this continuously records ECG while the patient is ambulatory and performing daily activities. The patient needs to keep a diary and record their activities and any symptoms they experience. Events in the diary are correlated with any dysrhythmias seen on the ECG.
Explain Holter monitoring
Event monitoring has improved the monitoring of patients in outpatient settings. Event monitors are recorders that the patient activates only when he or she experiences symptoms.
explain event monitoring
Exercise treadmill testing evaluates the patient's heart rhythm during exercise. If exercise-induced dysrhythmias or ECG changes occur, they are reviewed. If needed, drug therapy can be started and evaluated.
what is exercise treadmill testing?
sinus arrhythmia, where everything is normal, except it has an irregular rhythm
This type of arrhythmia varies with breathing
-NSM but irregular
-varies with breathing
ECG pattern where everything is normal, expect the rhythm is irregular
Normal, doesn't need any tx!
What's the ECG??
-P wave present
-QRS complex present
-Rate 60-100 bpm
-Equal distances between each beat (QRS complexes)
-PRI: 0.12-0.20 seconds
-QRS interval: >0.12 seconds
-this varies with breathing
-HR increases with inspiration
What is it?
-NSM but rhythm is irregular
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