Cardiac Monitoring

Question 1

What is the definition of Cardiac monitoring

Answer 1

Is a non-invasive procedure that displays the
electrical activity of the heart; these
electrical impulses are picked by the surface
electrodes and are transported and then
recorded in the ECG.

Question 2

Is the ECG placement an invasive or non-invasive procedure?

Answer 2

Non-invasive

Question 3

Purposes of Cardiac monitoring

Answer 3

1. Provide a continuous graphic picture of
   cardiac electrical activity.
2. Monitor oxygen saturation of the arterial
   blood.
3. Help in the diagnosis of life-threatening
   problems, such as cardiac dysrhythmias.

Question 4

Indications to perform cardiac monitoring

Answer 4

✓ Patients with suppressed respiratory
system by a drug overdose or anesthesia.
✓ Monitor the pattern of a child’s heart
rhythm pre- and post- surgery.
✓ Monitor abnormal heart rhythms.
✓ Monitor the effect of cardiac medications
have on a child’s heart rhythm.

Question 5

What is a lead system?

Answer 5

record the electrical activity generated by
cardiac tissue.

Question 6

TRUE OR FALSE: All cardiac monitors use the lead system to record the electrical activity generated by cardiac tissue.

Answer 6

TRUE

Question 7

Types of cardiac monitoring systems

Answer 7

Cardiac monitoring systems currently on
the market varies from three-electrode
telemetry devices to three, four, and five
electrode hard-wire systems.

Question 8

Examples of lead system

Answer 8

1. 3-electrode system
2. 12 lead ECG: pericordial leads
3. 5-electrode system

Question 9

What do we need to prepare for cardiac monitoring

Answer 9

A. Environment
B. Patient’s skin

Question 10

What materials do we need

Answer 10

*Bedside monitor
*Machine cables
*Three electrodes
*Sponge with alcohol
*KY gel
*Scissors

Question 11

What should we do on preparing the patient’s skin

Answer 11

*Shaving (for adolescent)
*Disinfectant with alcohol or soap
*Keep the skin dry

Question 12

When do we change the electrodes

Answer 12

Electrodes are to be changed every
24 hrs and selects an appropriate lead in
which to monitor the patient.

Question 13

Important reminders during cardiac monitoring

Answer 13

*Explains the purpose of ECG monitoring
to the patients and families.
*Applies the electrodes to the appropriate
location and attaches the correct cables to
each electrode.
*Check cables and lead wires for fraying,
broken wires or discoloration.
*Plug lead wires into patient’s cable.
*Plug the patient’s cable into monitor.

Question 14

Adjustments for turning on the monitor

Answer 14

-Speed (25mm/sec)
-Sets the appropriate alarm limits
based on the initial rate/rhythm and ensures
alarms are set to the ON position.

Pediatrics – Alarms are set that
are appropriate for the age or as ordered by
the physician.

Question 15

What should we look for during post care?

Answer 15

A. Patient
*Reassure the patient
B. Environment
*Discard the used items.
C. Nurse
*Record ECG strips from the monitor.
*Evaluate the ECG pattern continually for dysrhythmia.
* Wash hands.

Question 16

What should we do during ongoing care

Answer 16

✓ Checks the alarm limit settings at the start
of every shift and continues to adjust the
alarm as the patient’s rhythm and
condition warrant.
✓ Reviews every shift the monitoring trends
and alarms.
✓ Reassess the patient for signs of
hemodynamic compromise with any
significant changes in cardiac rate or
rhythm (i.e. BP, oxygen saturation, RR, or
myocardial ischemia).
✓ Reports to the physician:
* Life-threatening cardiac arrhythmias
and initiates appropriate actions.
* New or unexpected changes in the
cardiac rate, rhythm or clinical status.

Question 17

What is a hemodynamic compromise

Answer 17

Simply stated as “blood flow compromise”, which is anything that may prevent proper blood flow such as a hemorrhage, plaque atherosclerosis, etc.

Question 18

What to document

Answer 18

*Record the patient’s ECG.
*Record any dysrhythmia and treatment.

Question 19

SPECIAL CONSIDERATIONS: Is is true that all electrical equipment and grounded before using it?

Answer 19

TRUE

Question 20

SPECIAL CONSIDERATIONS: Is it true that patient must not be dried nor clean before the procedure?

Answer 20

FALSE: Patient must be dry and clean

Question 21

SPECIAL CONSIDERATIONS: Is i true that we must open the electrode packages before the procedure?

Answer 21

FALSE: Avoid opening the electrode packages until just before using them.

Question 22

SPECIAL CONSIDERATION: You can place the electrodes to areas that are bony, hairy, and anywhere in the chest

Answer 22

FALSE: Avoid placing the electrodes on bony prominences, hairy locations, areas where defibrillator pads will be placed, or areas for chest compression.

Question 23

SPECIAL CONSIDERATIONS: You can rub the skin of the patient with a dry gauze or alcohol pad when the patient’s skin is oily, scaly, or diophoretic before applying the electrode pad

Answer 23

TRUE

Question 24

SPECIAL CONSIDERATION: Have the patient breathe normally during the
procedure.

Answer 24

TRUE

Question 25

SPECIAL CONSIDERATION: Assess skin integrity, and reposition the electrodes
every 72 hours.

Answer 25

FALSE: It must be every 48 hours