Obtaining an ECG P and P and slides Flashcards by Willow Belanger

what represents atrial depolarization + contraction eg QRS, P wave, PR interval

PR interval

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what represents V depol + contraction

• QRS interval represents V depol + contraction

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t or f

the ECG reflects muscular work of the heart

f it monitors the regularity and path of the electrical impulse through the conduction system

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when might an ECG be used

• Used to monitor effects of meds, recovery of MI, or when chest pain occurs..preop baseline, prediagnostic baseline

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what is a dysrhythmia

• Dysrhythmia = any deviation from NSR (normal sinus rhythm) – result from ischemia, valvularabn, anxiety, drug toxicity, A-B imbalance

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which of the following are dysrhythmias
tachycardia, 
bradycardia, 
premature ventricular or atrial contractions (PVC, PACs), 
AFib, 
heart block

all dysrhythmias

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in a 12 lead ECG how many leads and electrodes are there and where are they in gen

any specific terms for the location

12 lead ECG includes bipolar limb leads I, II, II; augmented limb leads aVr, aVl, aVf and precordial chest leads V1 to V6
‘Precordial’ refers to the electrodes on the chest

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what is a lead (in reference to ECG)

what can it show yo

a lead is like a _____

Leads refer to the tracing of the voltage between the electrodes on the ECG printout.

• Each lead specific to different part of the heart to help detect where damage has occurred

a lead is like a camera

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what is the term for the electrodes on the chest

• ‘Precordial’ refers to the electrodes on the chest

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is a 12 lead or 3-5 lead used in emerg or for interpretive results

when else is this used

• 3 or 5 lead considered interpretive – used during emerg + pacemaker insertion. One electrode substituted sequentially for the 6 chest electrodes

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t or f a 12 lead ECG is considered diagnostic

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what is a holter monitor and what kind of data can it gather over what period of time

• Holter monitor used for continuous ECG over long period of time (small, portable, records for up to 24hrs)

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which lead is most commonly used for interpretation and what area of the heart does it show

lead II

Lead II (Camera II) shows us the inferior aspect of the heart. (this looks at the larger more muscular areas of the heart

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when might they focus on another lead for interpretation

• the pt will always have one lead that is represented all across the paper. It is not always lead II at the bottom. If the patient had something wrong with another area of their heart they might putthat one at the bottom

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what does it mean to have a positive inflection on the ECG

why are there neg or pos inflections

• the electrodes are like batteries. One is neg and one is pos. if moving towards the pos electrode it will have pos inflection…
If the current moves away from the positive electrode, you will see an inverted waveform

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what kind of lead would a patient be on if they were on telemetry

gen 5 lead

what woud you call a dysrhtyhmia that is…

Normal repsosne to exercise, emotion, pain, fever, hyperthyroidism + ceratin drugs

sinus tachycardia

what characteristics does a sinus bradycardia have

how might the pt present

Regular rhythm, rate <60bpm
Normal P, PR interval, and QRS complex

Assoc w decreased CO, dizziness, syncope, chest pain

Irregular rhythm followed by compensatory pause

what kind of rhtyhm is this
what causes it

Premature Ventricular Contractions (PVCs)

Caused by irritable focus; if more than 6 beats/min or pairs, indicated inc ventricular irritability

ventricular tachy
what is the clinical significance of this

rate?
P wave char
PR char
QRS char

Often a forerunner of V ib; may cause dec CO b/c dec V filling time

Rhythm slightly irregular; rate 100-200
P wave absent, PR interval absent, QRS wide and bizarre

assessment before applying ECG

what position ill they be in

Verify type of ECG ordered

* Pt’s ability to follow directions, remain still in supine

what can pt NOT do when you are applying the electodes

if they dont listen/cant follow what happens to results

Instruct pt to lie still w/o talking (12 lead only) and do not cross legs (movement produces artefact + skews results)

how do you prep the skin and site for application of electrodes

Clean + prep skin: wipe sites w EtOH (removes oil), clip hair if necessary.

why might proper application of electrodes be challening on emaciated pt

Difficult to do if pt emaciated d/t bony structures + no subcut fat

when applying the electrodes and leads where do you press and why

8) Apply self-sticking electrode, being careful to apply P on perimeter only. Attach leads. (P on center of lead displaces displaces gel + results in poor tracing)

where to place the limb leads? is proximal or more distal better? best to be right on the bone to stabilize it?

g. One lead on each extremity. Place on lower portion of each extremity, avoiding any bony prominences i. aVr – right wrist ii. aVl – left wrist iii. aVf – left ankle iv. aV7 – right ankle • limb leads should be near wrists and ankles but avoid the bony prominences. Just make sure in same spot bilaterally

not sure we need to know the placement

a. V1 – fourth intercostal space (ICS) at right sternal border b. V2 – fourth ICS at left sternal border c. V3 midway between V2 and V4 d. V4 – fifth ICS at midclavicular line e. V5 – left anterior axillary line at level of V4 horizontally f. V6 – L midaxillary line at level of V4 horizontally

not sure we need to know these which are the lateral leads and what do they look at

Lateral leads (I, aVL, V5and V6 ) Look at the electrical activity from the vantage point of the lateral wall of left ventricle

which are the septal leads and what do they look at

Septal leads (V1 and V2) Look at electrical activity from the vantage point of the septal surface of the heart (interventricular septum)

wich are the anterior leads and what do they show

Anterior leads (V3 and V4) Look at electrical activity from the vantage point of the anterior wall of the right and left ventricles (Sternocostal surface of heart)

once the pt is all hooked up what do you need to do what subjective thing do you need to document during the tracing

9) Turn on ECG, enter required demographic info into computer + obtain tracing a. Simultaneous 12-channel recording: enter pt name + MRN into ECG menu. Obtain test tracing. Reposition leads as needed. Activate machine to obtain simulatnaoeus tracing of all 12 leads. If pt experiences !chest pain!, document on ECG printout (pain often correlated to arrhythmia on ECG)

dont think we need to know how to get 3 or 5 lead recording

b. 3 or 5 Lead Recording: after placing limb electrodes, apply gel over V1 to V6 locations. - Turn lead selector to leads ‘1’, turn on machine + begin recording. If tracing clear, run sequential 6 second tracings for leads I, II, III, aVr, aVl + aVf by turning lead selector to corresponding settings. - Stop machine, position V electrode over V1 position, and run 6 sec tracing. Repeat by moving V electrode over V2, V3 etc…

if serial tracings are expected what might the cardiologist ask you to do

mark where they were placed for consistency

what to record and report after obtaining ECG

* When ECG was obtained (date + time) and where tracing was sent, rationale for obtaining ECG (pain, discomfort, before or after sx), and baseline VS. Include rhythm strip in pt chart * Report any arrhythmias or chest pain to HCP immediately

if ECG cannot be interpreted b;c of absence of tracing in one or more leads; presence of electrical artifact in tracing what do you do?

Inspect electrodes Reposition any leads that move as result of pt breathing or movment or vibrations in environment + repeat tracing Remind pt who moves that it is necessary to lie still If artifact looks like 60-cycle interferences (very thick-lined waveform) unplug battery-operated equipment in room oneat time to see if interference disappears (note: 60-cycle interferene is rare)

your pt is getting sweaty but youre afraid of changing the results by reapplying the electrodes what should you do

you need to reapply as sweat will affect the readings

your pt has chest pain or anxiety during ECG what to do

Continue to monitor Reassess factors contributing to anxiety Follow specific postoperative orders r/t findings Notify HCP

if 5 lead placement where do you put the electrodes the upper ones the lower ones V1 helpful way to remember the colors

Upper electrodes placed just below clavicles, Lower electrodes placed at lower edge of ribcage V1 4th intercostal space to R of sternum White goes to upper R-white is like a cloud and clouds are over grass. Green goes under ribcage on r. smoke over fire. Brown for heart

is positioning of 5 lead different when doing continuous and telemetry readings

Same positioning used whether continuous monitoring via bedside monitor or using telemetry pack