Download Electrocardiogram (ECG/EKG) Procedure and Interpretation and more Lecture notes Nursing in PDF only on Docsity!
RELATED LEARNING EXPERIENCE
ECG/EKG
ELECTROCARGIOGRAM
→It is a process of viewing the electrical impulse transmission in the heart muscle and represents by the end product “electrocardiogram waveform results” (ECG strips) 1 Electrical activity of the heart 2 Myocardial oxygenation 3 12 lead ECG PURPOSES
- To determine the cardiac rhythm, pattern variations/pathologic processes, chamber enlargement and electrolyte imbalances. EQUIPMENTS - ECG MACHINE - 10 ELECTRODES
ELECTRODES PLACEMENT
6 Chest 4 Limbs LIMP LEAD PLACEMENT →Connect the lead wires to the electrodes. →The tip of each lead wire is lettered and color-coded for easy identification. RED RA RIGHT ARM YELLOW LA LEFT ARM BLACK N/RL RIGHT LEG GREEN LL LEFT LEG NOTE : The patient’s chest and all four limbs should be exposed to apply the ECG electrodes correctly.
- There are different methods for identifying the correct landmarks for ECG electrode placement, the two most common being the ‘Angle of Louis’ Method and the ‘Clavicular’ Method (Crawford & Doherty 2010a).
RELATED LEARNING EXPERIENCE
To find these correctly, the ‘ANGLE OF LOUIS’ Method can be used:
- To locate the space for V1 ; locate the sternal notch ( Angle of Louis ) at the second rib and feel down the sternal border until the fourth intercostal space is found. V1 Right of the sternal border V2 Left of the sternal border. V3 Directly between V2 and V4. V4 Fifth intercostal space in the midclavicular line (as if drawing a line downwards from the center of the patient's clavicle). V5 Directly between V4 and V6. V6 Fifth intercostal space at the mid- axillary line (as if drawing a line down from the armpit). ✓ V4 should be placed before V. ✓ V4-V6 should line up horizontally along the fifth intercostal space. ▪ V1-V2- “septal leads ” primarily observes the ventricular septum but may occasionally display ECG changes originating from the right ventricle. ▪ V3-V4- “anterior leads”, observes the anterior wall of left ventricle. ▪ V5-V6-: anterolateral leads” observes the lateral wall of left ventricle Limb Placement LIMB PLACEMENT ▪ The limb leads their view of the heart’s electrical activity. NOTE : The electrode on the right foot is not included in any leads but serves as a ground wire Lead I, II, III Willem Einthoven’s leads Lead aVR,aVF,aVL Goldberger’s leads
RELATED LEARNING EXPERIENCE
INHERENT RATE
SA NODE 60 - 100 BPM
AV NODE 40 - 60 BMP
BUNDLE OF HIS 40 - 60 BPM
L & R BUNDLE BRANCHES 20 - 40 BPM
PURKINJE FIBERS 20 - 40 BPM
WAVES, COMPLEXES, AND INTERVALS
P WAVE
→ Electrical impulse coming from the sinus going to the atria. →Atrial Depolarization → Atria are contracting. QRS COMPLEX → Represents ventricular depolarization. → Ventricles are contracting.
RELATED LEARNING EXPERIENCE
T WAVE
→ Represents ventricular repolarization. → Ventricles are relaxing. U WAVE → Represents the repolarization of the Purkinje Fibers. PR INTERVAL → Measured from the beginning of the P Wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction to the AV node before ventricular depolarization.
ST SEGMENT
→ Represents early ventricular repolarization. →Place where cardiac ischemia is being assessed. QT INTERVAL → Represents the total time for ventricular depolarization and repolarization. → Place where ventricular dysrhythmia is being assessed. TP INTERVAL → It is measured from the end of the T wave to the beginning of the next P wave. PP INTERVAL → It is measured from the beginning of the one P wave to the beginning of the next. RR INTERVAL → It is measured from the beginning of one R wave to the beginning of the next.
RELATED LEARNING EXPERIENCE
ABNORMAL COMPONENTS
P WAVES (ABNORMAL)
→Left or Right atrophy
P WAVES (ABSENT)
→Atrial Fibrillation →Severe Hyperkalemia → Sinus Node Arrest P-P INTERVAL (VARYING) →Mobitz Type 1 →Atrioventricular Block →Multifocal Atrial Tachycardia QRS COMPLEX (WIDE) →right or left bundle branch block →ventricular flutter →ventricular fibrillation →hyperkalemia QT INTERVAL (LONG) →Mi →Stroke →Hypokalemia →Hypothyroidism →Intracerebral Hemorrhage →Hypomagnesemia →Cardiomyopathy →Myocarditis ST SEGMENT (DEPRESSION/ABNORMALLY LOW) →Pulmonary Embolism →Myocardial Ischemia →Left Bundle Branch Block In Leads V5 And V
RELATED LEARNING EXPERIENCE
→Hyperventilation →Hypokalemia ST. SEGMENT (ELEVATED) →Pulmonary Embolism →Left Bundle Branch Block Leads Vi V →Left Ventricular Hypertrophy →Myocardial Ischemia →Pericarditis →Hyperkalemia →Acute Myocardial Infarction T WAVE (TALL) →Hyperkalemia →Acute Myocardial Infarction →Left Bundle Branch Block →Stroke →Ventricular Hypertrophy T WAVE (FLATTENED, INVERTED, SMALL) →myocardial ischemia →hyperventilation →anxiety →drinking hot and cold beverages →left ventricular hypertrophy →digoxin →pulmonary embolism →pericarditis →right bundle branch block →hypokalemia →stress →cardiomyopathy PREPARATION
**1. Verify the order for the ECG in the patient’s chart.
- Confirm the patient’s ID by checking two client identifiers according to hospital’s policy
- Provide privacy and explain the procedure.** ▪ Explain that the test records the heart’s electrical activity and that it may be repeated at certain intervals. ▪ Emphasize that no electrical current will enter the body. Tell the client that the test typically takes about 5 minutes. ▪ Ensure the patient’s privacy and dignity: e.g. by closing the room door or drawing around the curtains. PREPARING A PATIENT FOR AN ECG
- Maintain good infection control practice by washing your hands prior to patient contact.
- Skin preparation is important. If the patient’s skin is dirty, clean with soap and water, and then dry. ▪ If the skin is oily or the patient applied any creams or lotions, use an alcohol wipe to clean each electrode placement site.
RELATED LEARNING EXPERIENCE
▪ In a large-breasted woman, you may need to displace the breast tissue laterally.
- Connect the lead wires to the electrodes. The tip of each lead wire is lettered, and color coded for easy.
- Now, you are ready to begin the recording. Ask the patient to relax, not to talk, and breathe normally while you record ECG.
- Press the PRINT button. Observe the tracing quality.
- When the machine finishes recording, remove the electrodes and clean the patient’s skin.
- After disconnecting the lead wires from the electrode, CLEAN and DRY the electrodes as per manufacturer instructions.
- Assist the patient in a comfortable position. Be sure that the bed is in a low position.
- Remove any remaining equipment. 14. Wash your hands. 15.Document in your notes the test’s date and time and significant responses by the patient. Note any appropriate clinical information on the ECG. ▪ LABEL ECG RECORDING WITH PATIENT’S NAME , DATE TIME AND SIGNATURE. After Procedure Video: Check sample video https://www.youtube.com/watch?v=30FmTdI qtSE
