Chapter 4: Cardiac Monitors

hardwire and telemetry
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tanglingkeep the lead wires separated from each other to avoid _____looselyposition the lead wires _____ across the pt so they do not pull on and lift the electrodes away from the skinclean and decontaminateproperly _____ and _____ the lead wires after each usedisposableECG *electrodes* are typically _____electrolyte gelelectrodes consist of: -wet or dry _____ _____ which acts to *assure good signal* pick up -metal snap or tab where the ECG lead wire is attached -self adhesive pad that hold the electrode to the skinclean clipto achieve a noise free recording: -_____ the skin to remove dead skin cels and oils -_____ dense hair present at the sites where the electrodes are to be placesmuscle tensioneliminate _____ _____ by placing the pts arms and legs in a comfortable position in which the extremities are resting on a supportive surfaceartifacts_____ occurs when the pt moves too much, breaths too heavily etc during the ECG and creates false wavesconductive gel may dryavoid removing electrodes form their sealed protective envelope before use... why?attach the electrode to the lead wire before placing the electrodes onto the pts skinwith *snap on lead wires* how should they be prepared?apply the connector to the metal snap of the electrode after the electrode has been placedwith *clip on type lead wires*, how should they be prepared?soft tissuelook for a *flat surface* ad sites over _____ _____ for electrode placementlarge bones thick muscle skin foldswhat 3 areas should be avoided in electrode placement?imaginary lineECG leads: are a combination of electrodes that form an _____ _____ in the body along which the electrical signals, detectable during the time course of the heartbeat, are measureddifferent viewECG leads: each lead provides a _____ _____ of the heartchest, arms, and legselectrodes are places on what 3 areas? -electrode sites vary depending on which view of the hearts electrical activity is being assessedpositive electrode*deflections* off the waveforms seen on the ECG depend on where the _____ _____ is placed in comparison to the direction of the electrical forcesbipolar or unipolarECG leads are either _____ or _____bipolar leads-record the flow of the electrical impulse between two (one is *positive*, the other is *negative*) selected electrodes -includes *I, II, and III*Einthoven's Triangle_____ _____ is based off the theory that the heart is at the center of the *bipolar leads of I, II, and III*bipolar leads-record difference in electrical potential between a positive and negative electrode -*uses a third electrode called a ground* -includes leads *I, II, and III*unipolar leads-use *only one positive electrode* and a reference point *calculated* by the ECG machine -includes leads *aVr, aVL, aVf, and V1 through V6*frontal and horizontalelectrodes are placed on the extremities and chest wall to view the heart's electrical activity from the _____ and _____ panes -provides a cross sectional view of the heartfrontal plane-leads that view this plan are called *limb leads* -include leads: *I, II, III, aVr, aVL, and aVf* -provide *inferior, superior and lateral views* of the hearthorizontal plane-leads that view this plan are called *precordial or chest leads* -includes leads: *V1, V2, V3, V4, V5, and V6*1) a specific part of *ECG complex* 2) electrical event of a specific *cardiac cycle* 3) *conditions* such as an enlargement of heart muscle, or presence of ischemia, injury, and infarctiondifferent lead uses... a given lead may be used to highlight what 3 things?RA electrode-positioned anywhere on the *right arm* or *below the right clavicle in the midclavicular line*LA electrode-positioned anywhere on the *left arm* or *below the left clavicle in the midclavicular line*LL electrode-positioned anywhere on the *left leg* or *left midclavicular line bellow the last palpable rib*RL electrode-positioned on the *right leg* or *right midclavicular line below the last palpable rib*chest leads-positioned in order *across the chest*V1which chest lead... -4th intercostal space to the right of the sternumV2which chest lead... -4th intercostal space to the left of the sternumV3which chest lead... -directly *between* the leads *V2 and V4*V4which chest lead... -5th intercostal space at midclavicular lineV5which chest lead... -*level with V4* at left *anterior axillary line*V6which chest lead... -level with V5 at *left midaxilary line*; directly under the midpoint of the armpitunipolar leads-use *one positive electrode* and a reference point which is *calculated by the ECG machine*Lead Iwhich lead? Positive Electrode: Left Arm Negative Electrode: Right Arm Ground Electrode: Left Leg -waveforms are positiveLead IIwhat lead? Positive Electrode: Left Leg Negative Electrode: Right Arm Ground Electrode: Left Arm -waveforms as positiveLead IIIwhat lead? Positive Electrode: Left Leg Negative Electrode: Left Arm Ground Electrode: Right Arm -all waveforms are positive or biphasicAugmented Leads-includes *aVr, aVL, aVf* -*unipolar* -enhanced by ECG machine because waveforms produced by these leads are normally smallLead aVrwhich augmented lead? -positive electrode paced on right arm -waveforms have negative deflectionLead aVLwhich augmented lead? -positive electrode place on left arm -waveforms have positive deflectionLead aVf-positive electrode located on left leg -waveforms have a positive deflectionincludes leads: V1, V2, V3, V4, V5, and V6precordial leads? -positioned in order across the chest -*unipolar*: opposing pole is center of heart as calculated by ECGLead IIECG electrode polarity -positive electrode: LL lead wire -negative electrode: RA lead wire -ground electrode: LA lead wire -produced positively deflected waveforms