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Electrocardiography, ventricular dysrhythmias part 1, cardiac testing,…

- - - - AED
- - - - what we must do
    - - what we should do
        
        standards of behavior based on our morals and values
    - - health insurance portabiloty and accpuntability act
        
        oprotection for patient's healthcare information
        
        patient determines who can and cannot see and use information
        
        information is onlyy shared with those involved
  - - - electronic
      - paper
  - - - comminication
      - positive relationship
      - active listening skills
      - skilled interview techniques using open ended questions
    - - assiting in understanding te procedure and following instructiins
        
        disability
        
        culture and language
        
        religion
        
        developmental level
        
        gender
- - - - use correct BF cuff size
      - placed 2/3 the distnace between the elbow and shoulder
      - BP cuff and stethoscope should not touch
- - - - if thr mpulse occurs somwhere inthe pathway betwen 2 qnd 3 instead of 3 and 4 a pvc would be a result, caffine, alchollh or other cuases hormonal
  - - - six second method must be used with this irregular rhythm
        
        include the irregular waves too
  - - - rae skow 20-40 bpm
      - rate elivated is 40-100 bpm is accelerated
      - p-p interval cannot bw determined
      - r-r interval os regular
      - p wave is absent
      - qrs complex is wide and bizarre in apperance
- - - - white lead right sholder
      - black lead
        
        left sholder
        
        red lead abdoninal area
    - - same as three lead
        
        white leade right shoulder "black lead left sholder "red lead abdominal area
        
        two additional leads
        
        green lead ground
        
        right lower abdomen
        
        brown lead to the right of the sternum
- - - - white at the right sternal border
      - red at right sternal border
    - - black at left anterior axillary line
      - brown at the left sternal brorder
    - - green at right thoracic or abdominal area
  - - - the patient will record the date and tune oid=f any events and symptoms
      - all unusua and usual daily activituties are recorded
      - date and time of medication taken is recorded
- - - - stress test monitorn=ing
        
        report arrhythmias
        
        monitor blood pressure continuously
  - - - transitions to increased speed and incline every 3 minutes
        
        target heart rate
        
        220 patients age x 0.85 = targe heart rate
        
        protocals based on age , weight and other factors as determined by cardiologist
        
        220 0- 65= 155
        
        155 x 0.85 =132
    - - test willll be stioed if the patient expereinces
        
        syncope
        
        nausea and vomiting
        
        intense chest pain
        
        shortness of breath extream atigue
      - syncope is a result of decreased oxygen to the brain and an aed may require for cardaic arrest
        
        one pad placed on the rght ofupper sternum
        
        one pad paced at ledt miaxillary line
- - - - moitored as awith and stress test
        
        iv carido active medications are given to mimic stresss placed om the heart during exercise
  - - - iv cardiac medications are given
        
        radioacive stracer is used eith gramma camera
  - - - atress echocadriogram combines sound and a tredmill
        
        chemical stress echocardiogram combines sound and chemical
- - - - form einthoven's triangle
      - right leg is not included but rather is a ground lead
  - - - aVR
        
        right arm
      - aVL
        
        left arm
      - aVF
        
        left foot
  - - - unipolar
      - v1 through V6
  - - - standard lead 1, 11, 111 produce positive defections on the graph
    - - augmented lead a VR produces a negative deflection
      - augmented leads a VL and aVF produce positive deflections
    - - chest leads V1 through V6 are precordial leads , providing a view of the heart from different angles
  - - - p eave occurs at the begining of atrial contraction or depolarization
      - PR interval represents complete atrial contraction 0.12 to 20 seconds
      - qrs complex represents contraction or depolarization , of the ventticles 0.01 to .12 seconds
      - ST segment is the time between the end of ventricular contraction and the begining of relaxation
      - t wave represents ventricular relaxation or repolarization
      - QT itnterval starts at the begining of QRS through the end of the T wave
      - u wave can follow t wave
- - - - produce a page of 12 tracings
      - recordig=ng takes about 10 seconds
  - - - regulates hoe fast or slow the paper runs through the ECG nmachiine
        
        standard is 25 mm / second
        
        increased to 50 mm second for a fast heart rate
        
        decreased to 5 or 10 mm for a very slow heart rate
        
        always document any apeed changes
    - - regulates the heaight of the QRS complex
        
        standard is 10 mm / mV
    - - patient data is entered
      - displays error information
      - displays ecg results
    - - are used to set a high and low limit for heart rate
        
        analarm will sound if the patients goes ebove or below the minit
      - a lead selector allows a lead to be run seperatly
        
        used of one of two leadss need to be reapeated and run seperatly
- - - - ECG styus is hot mari=king the paper with the electrical acivity of the heart
- - - - least accurate
        
        300 large boxes equal 1 minute strip
        
        determine how many large boxes between two r waves and divide into 300
  - - - 0.-4 x 1500 = 60 seconds
      - 1500 small boxes equal 1 minute strip
      - determine how many small boxes between two R waves and divide into 1500
- - - - includes p wave and space prior to Q wave
      - beginning of atrial relaxation ( repolarization
      - beginning of ventricular contraction (depolarization)
    - - includes QRS waves
      - completrion of ventricular contraction
      - completion of atrial relaxation (repollarization
      - 0.06 to .12 seconds
      - J point indicates end of time period
    - - small upward curve
      - contraction of the atria
    - - from end of QRS complex to beginning of t wave
      - beginning of ventricular relaxation (repolarizationn )
    - - small upwaard cureve
      - complete relaxation of ventricles (repolarization
    - - not always seen
      - small upward curve following T wave
- - - - p to p intervals
      - are they equal across the 6 second tracing
  - - - measure from the same wave for each (from R to R waves)
  - - - 300 method
      - 1500 method is the most accurate
      - 6 second method
- - - - change in mental status or dizziness
      - chest pain or discomfort
      - difficulty breathing
      - low blood pressure
- - - - p to p and r to r intervals are irreular
- - - - p wave can be inverted
      - burried in the qrs complex
      - follow the qrs complex
        
        the Patient will probably not show and signs of symnptoms unless there are 4-6 pjcs in a row
    - - travels throught the atrial ventriclar AV node
        
        and atrial ventriculrar bundle
        
        impulse travels throught eh interventricular septum to the maningie finders
  - - - AV junction pacemaker
      - p wave may be inverted or may not be seen
- - - - palpitations
      - racing feeling in chest
    - - low cardiac output
      - low bloood pressure
      - mental status changes
      - difficulty breathing
- - - - 1 rhythm
        
        determination of the rhythm
      - 2 rate
        
        determinatrion of the rate
      - 3 p wave
        
        shape of the p wave
      - 4 PR interval
        
        measurment of the PR interval
      - 5 QRS complex
        
        duration and shape of the qrs complex
- - - - V 7 V8 V9 on left
      - V7 -R V8 -R and V9- R on right side
- - - - provide a few minutes for the patient to relax
      - ask patient put their hands under their buttocks witht he palms down
  - - - check electode connections
      - remind the patient to lie still
  - - - unplug any equipment plugged into the same outlet or near the
        ecg machine
  - - - check for frayed or loose lead wire
- - - - set up with procedure table and ECG table
      - keep ECG supplies stocked
      - ECG machine on cart
  - - - name
      - date of birth
      - hospital ID or medical record number
    - - verbal consent
      - implied consent by actions
      - refusal is patients right
      - alert physician if patient declines or refuses consent
    - - enter into LCD display
        
        name
        
        hospital id or medical record number
        
        date or birth
        
        age and gender
        
        medications being taken
        
        vital signs
    - - reassure the patient
      - provide privacy to disrobe
      - put on gown with opening in the front
      - long pants are rolled up
    - - raise patient to a 45 degree angle if breathing problems are present
      - use proper body mechanics if nessessary to lift or move patient
- - - - electrical generator
      - two or three lead wires
- - - - both spikes
- - - - 7 x 0.04 = . 28 pr interval duration
    - - always momotor the patient
  - - - mobits tyoe 1 (wenchebach
        
        pp interval is regular
        
        r-r interval is iregular
        
        p wave is normal shape
        
        pr intervals progressively gets longer , usually greater than .2 seconds in duration
        
        lengthen... lengthen ... drop... equals wenckebach
        
        patient status
        
        low cardiac output with heart rate of 40 bpm or lower
      - mobitz type 11
        
        p-p is regular
        
        r-r is regular or iregular
        
        p wave is normal is shaoe
        
        pr interval is consnant with i=missing qrs complexes
        
        patint status
        
        high unstable
        
        low cardiac output
        
        critiical condition
        
        can quickly progress to third degree block
  - - - p-p intervals is measured first and is regular
      - r-r interval is regular
      - atrical rate is within nrmal
      - ventricular rate is between 20 and 40 bpm
      - p wave if seen has normal shape and size
      - pr interval and qrs complex vary in diration