unit 4 big test Flashcards
1
Q
what starts the pumping of the heart muscle
A
electrical activity
2
Q
what causes the electrical current in the heart muscle
A
chemical changes in the cells of the heart
3
Q
what is the state of a resting cell
A
negative charge
4
Q
what is the mechanical response to depolarization (cell turns positive)
A
systole
5
Q
why type of electrode is only used for a short time
A
resting
6
Q
when would you chose monitoring electrodes over resting electrodes
A
when the electrodes must stay on the patient longer
7
Q
what is telemetry used for
A
ongoing mobile monitoring in a hospital setting
8
Q
how many leads are used in telemetry
A
5
9
Q
what is a holter monitor used for
A
ongoing mobile monitoring outside of an inpatient setting
10
Q
what is continuous monitoring used for
A
ER, ICU, or bedside monitoring without movement
11
Q
how many leads are viewed in continuous monitoring
A
3-5
12
Q
what is a 12 lead EKG used for
A
evaluating heart rhythm and signs of heart diease
13
Q
what is a stress test used for
A
evaluating for heart disease when heart rate is increased
14
Q
how many leads are used in a stress test
A
12
15
Q
which electrode is positive and negative in lead 1
A
LT arm positive, RT arm negative
16
Q
which electrode is positive and negative in lead 2
A
LT leg positive, right arm negative
17
Q
which electrode is positive and negative in lead 3
A
left leg, left arm
18
Q
what is positive and negative in the augmented leads
A
in each lead a different limb is positive, the negative is always the central terminal
19
Q
what are the positive electrodes in aVR, aVL, and aVF
A
right arm, left arm, and the leg left
20
Q
what are the precordial leads
A
v1-v9
21
Q
what is the negative in the precordial leads
A
the central terminal
22
Q
which leads look at the inferior wall of the heart (right coronary artery)
A
lead 2, lead 3, and aVF
23
Q
which leads look at the anterior wall of the heart (left anterior descending)
A
v1, v2, v3, v4
24
Q
which leads look at the left lateral wall (circumflex)
A
lead 1, aVL, v5 and v6
25
what is the default speed of EKG paper
25 mm/sec
26
what is the default gain (sensitivity) of EKG
10 mm/minivolt
27
what happens if you speed up the tracing of EKG paper. when you you do so?
the waves spread out. this is used for fast rhythms.
28
what happens if you increase the gain of EKG tracing? when would you do so?
the waves become taller. when waves are hard to identify
29
when would you decrease the gain (make waves shorter)
if they are overlapping vertically
30
what are the colors of lead 1, 2, and 3
white, red, and black (white on right, smoke over fire)
31
what color is v1 and the one below it (RL)?
brown and green (dirt over grass below the clouds)
32
how should a patient be positioned for an EKG
laying down (supine or semi-fowlers)
33
what do you need to examine tracing for when an EKG is complete
clear tracing and fix issues before removing wires. check for signs of dangerous arrhythmias
34
who removes wires from patient? who removes electrodes?
the EKG tech, the patient
35
If the patient needs multiple EKGs can you leave the electrodes in place?
check the package, it will tell you if they can be reused
36
what equipment is necessary for applying telemetry?
a pack with batteries, lead wires, electrodes (monitoring style), towel, clippers, instructions
37
how are the steps for applying a telemetry pack similar and different from applying a 12 lead EKG?
they use the same skin prep and placement of leads on the torso. they are different in the amount of wires used, the patient must carry a transmitter with telemetry, the amount of time they are used for, and telemetry requires patient teaching
38
what are stress tests used for
checking heart function, future heart problems, planning for a heart procedure, routine screenings, family history, and heart surgery follow-ups
39
how is stress induced during a stress test
exercise or injection of medication that increases HR
40
how is a nuclear stress test special
it is done in addition to a normal stress test and it provides brain imaging to see where blood is not flowing
41
how is the patient positioned during a nuclear stress test?
they are laying down with arms above head
42
when is the imaging for a nuclear stress test done
before and after the plain stress test
43
how many hours before a stress test must a patient avoid caffine?
24, potentially 48
44
how long before a stress test should a patient be NPO
3 hours
45
what must patients bring with them to the test
all of their medications
46
what should patients avoid before a stress test
beta blockers
47
how long do stress tests normally last?
2-4 hours
48
when is the first 12 lead EKG done during a stress test
3 EKGS are done before the exercise portion. one laying, one standing, and one hyperventilating
49
how often are vital signs recorded during a stress test
following Bruce's protocol, every 2-3 minutes, and always prior to an increase in incline or speed
50
what is a requirement for the the stress test to be valid
patient's HR must reach 85% of their maximum heart rate zone
51
what training besides an EKG cert is required to perform a stress test?
CPR certification
52
what equipment is necessary to have in a stress testing facility
a crash cart, electrodes, clippers, towel, BP cuff, pulse ox monitor, oxygen
53
what symptoms require you to stop a stress test
dizziness, SOB, chest pain, increase in systole BP greater than 10 mmHg, decrease in systolic BP greater than 10 mmHg, systolic BP greater than 250 mmHg, diastolic BP greater than 115 mmHg, leg cramps, severe diaphoresis, worsening arrhythmias, patient asks to stop, rate does not go above 120
54
when can an EKG tech stop monitoring a patient after a stress test is complete
vitals are checked every 5 minutes until the 15 minute mark. tech can stop monitoring when vital signs return to baseline
55
how long does a holter monitor record activity for
24-48 hours
56
how must you prepare the skin for holter monitoring
clean with soap and water, abrade
57
what should be sent home with a patient that is having holter monitoring
monitoring equipment with batteries, medical tape, a journal
58
what should a patient do if their electrode becomes loose or falls off
notify their office and retape
59
what must a patient document when they are using a holter monitor
anything that might change HR< medications, activities, symptoms
60
when would patients push the event button
when they feel concerning symptoms
61
why would a physician order an event monitor
to log activity for longer than a holter monitor. EMs can track for 1-2 weeks.
62
how are looping event monitors different from nonlooping
looping event monitors constantly record, while nonlooping do not record anything leading up to an event
63
what is the purpose of a stress loop
to give slack to the wire so the electrode can withstand more tug
64
where is a nonlooping event monitor placed when patients have symptoms
directly over the heart
65
which laws protect the privacy of protected health information
HIPAA, and HITECH
66
how should you position a patient with orthpnea
semi-fowlers or high-fowlers
67
what cant a pregnant women be positioned laying down
we must keep pressure off the vessels tracing to the fetus
68
how should you position a woman who is 6+ months pregnant during an EKG
semi-fowlers, propped on the left side
69
if you can not place the electrodes on the correct spots on the chest, where should you place them
as close to their normal location as possible
70
what are the locations of v7, v8, and v9
left posterior MAL, middle of left scapula, left vertebral border
71
why would a posterior lead EKG be done
to view the back of the heart or to view the right atrium
72
why are pediatric electrodes moved
the heart is tilted to the right in ages 2-12
73
if a person has an injury, large breasts, or implanted devices where electrodes should be placed, how should you place them
move to the closest location that is not impacted by these.
74
what types of artifact are always caused by environment
broken recording an electrical interference
75
what can you do to reduce electrical interference
remove devices from proximity, unplug unnecessary equipment, do not use extension cords,
76
what is dextrocardia
when the heart points to the right rather than the left
77
what might cause artifact
temperature, faulty equipment, the patient
78
what types of artifact are caused by muscle action
somatic tremor and wandering baseline
79
choppy distortion throughout tracing indicates which artifact
somatic tremor
80
how can you reduce artifact from tremors
place hands under butt, move leads to torso, increase temp or room/give blanket, encourage deep and slow breathing (if patient is nervous)
81
what is a normal activity that may cause wandering baseline
breathing
82
how can you adjust electrodes if breathing is causing artifact
place the leads on the limbs rather than the chest
83
what can cause wandering baseline
bad contact with skin, breathing, patient moved
84
what causes broken recording artifact
wires or electrodes are loose, broken wires
85
how do you treat broken recording artifact
check the electrodes in leads that you are seeing the pattern, replace
86
what is the pre stage of hypertension
elevated bp, 120-120 systolic and less than 80
87
what is the first stage of hypertension
stage 1 130-139 systolic or diastolic 80-89
88
what is the the second stage of hypertension
systolic greater than 140 or diastolic greater than 90
89
what is a hypertensive crisis
systolic over 180, diastolic over 120
