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Cardiovascular, ECG and Vital Signs > Chapter 12 Cardiopulmonary Procedures > Flashcards

Chapter 12 Cardiopulmonary Procedures Flashcards

1
Q

P wave

A

Contraction of the Atria

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2
Q

Q wave

A

Contraction of the ventricles

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3
Q

T wave

A

aka ventricular repolarization, relaxation

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4
Q

QRS complex

A

the depolarization of the ventricles

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5
Q

P-R segment

A

the time between the end of atrial depolarization and the beginning of ventricular depolarization

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6
Q

S-T segment

A

from the end of ventricular depolarization to the beginning of repolarization of ventricles

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7
Q

Baseline

A

after T wave or U wave, period when entire heart returns to resting or polarized state

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8
Q

segment

A

time between two waves

-p-r segment, s-t segment

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9
Q

interval

A

length of a wave or length of wave with a segment

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10
Q

Q-T interval

A

time interval from the beginning of ventricular depolarization to the end of repolarization of the ventricles

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11
Q

P-R interval

A

time interval from the beginning of atrial depolarization to the beginning of ventricular depolarization

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12
Q

Normal standardization mark

A

10 mm high and 2 mm wide

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13
Q

electrocardiograph paper

A

thermosensitive paper divided into two sets of squares: small squares and large squares

-physician uses graph to measure waves, intervals and segments

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14
Q

electrocardiograph must be ________________ for every recording

A

standardized,

it is a quality control measure

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15
Q

if standardization mark is more or less than 10 mm high:

A

the machine must be adjusted, consult operating manual for adjustment information

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16
Q

Lead

A

a tracing of the electrical activity of the heart between two electrodes

  • each lead provides an electrical photograph of heart’s activity from a different angle
  • results in 12 photographs
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17
Q

Electrode (electrolyte)

A

a substance that facilitates the transmission of the heart’s electrical impulses

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18
Q

amplifier

A

device located in machine that amplifies the electrical impulses.
-electrical impulses given off by the heart are very small 0.0001 to 0.003 volt, therefore it must be amplified

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19
Q

galvanometer

A

changes amplified voltages into mechanical motion

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20
Q

The 10 lead wires:

A
  • 4 limb lead wires (right and left arm, right and left leg)

- 6 chest lead wires

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21
Q

The right leg lead is used for ____________.

A

grounding of the machine,

not used for recording, serves as an electrical reference point

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22
Q

Electrodes _________ amplify the electrical impulses.

A

DO NOT

*note: the electrocardiograph amplifies

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23
Q

Lead I

A

records electrical current between right arm and left arm

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24
Q

Lead II

A

record electrical current between right arm and left leg

-shows hearts rhythm more clearly than other leads

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25
Q

Lead III

A

records electrical current between left arm and left leg

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26
Q

bipolar lead

A

aka stander lead, uses two limb electrodes to record electrical activity of heart

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27
Q

Rhythm strip

A
  • longer recording (12 inches) of lead II
  • often requested by physician
  • confirms if there is dysrhythmia
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28
Q

aVR

A

augmented voltage-right arm; records electrical current travelling between right arm and a central point between left arm and leg

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29
Q

aVL

A

augmented voltage-left arm; records electrical current travelling between the left arm electrode and a central point between right arm and left leg

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30
Q

aVF

A

augmented voltage-left leg or foot; records electrical current travelling between left leg electrode and a central point between right arm and left arm

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31
Q

3 augmented leads

A

aVR, aVL, aVF

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32
Q

V1, V2, V3, V4, V5, V6

A

record heart’s voltage from front to back of heart

-from a central point “inside the heart, to a point on the chest wall

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33
Q

Leads must be properly located to:

A

ensure an accurate and reliable recording

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34
Q

Normally ECG is recorded with paper moving at a speed of ________.

A

25 mm/second

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35
Q

Recommended position for ECG V1 chest electrode

A

fourth intercostal space at right margin of sternum

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36
Q

Recommended position for ECG V2 chest electrode

A

fourth intercostal space at left margin of sternum

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37
Q

Recommended position for ECG V3 chest electrode

A

midway between positions 2 and 4

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38
Q

Recommended position for ECG V4 chest electrode

A

fifth intercostal space at junction of left midclavicular line

-at nipple

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39
Q

Recommended position for ECG V5 chest electrode

A

at horizontal level of position 4 at left anterior axillary line

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40
Q

Recommended position for ECG V6 chest electrode

A

at horizontal level of position 4 at left midaxillary line

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41
Q

preparation for an ECG

A
  • ask patient not to exercise before procedure,
  • to wear loose clothing or clothing that is easily removed
  • no oil, body lotion or powder
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42
Q

maintenance of electrocardiograph

A

use a soft cloth slightly dampened with a mild detergent to remove dust and dirt

  • clean patient cable, lead wires and power cord periodically with a moistened cloth and disinfectant
  • inspect cables for cracks and fraying-check metal tip of each lead wire for gel or residue
  • clean alligator clips
43
Q

three-channel recording capability

A

records electrical activity of three leads simultaneously and sensitively

44
Q

single-channel recording capability

A

records only one lead at a time

45
Q

What patient information is recorded on the top of the ECG chart?

A

patient’s name, DOB, Gender, date and time of procedure

46
Q

Teletransmission

A
  1. transmits recording electronically over phone line to ECG data interpretation site
  2. interpreted by cardiologist
  3. electronically transmitted to sending office on the same day
47
Q

interpretive elctrocardiograph

A

built-in computer program, analyzes recording as it’s being run, provides immediate information on heart’s activity

-patient’s data must be entered before running (name, sex, height, weight, medications, +reason for interpretation)

48
Q

artifact

A

additional electrical activity picked up by electrocardiograph
-interferes with normal appearance of ECG cycles

49
Q

EMR

A

electronic medical record allows electrocardiograph to be linked with office computer; digital image of ECG sent to computer

  • software analyzes ECG
  • can copy and print out ECG, then report reviewed and interpreted by physician and stored electronically in patient’s EMR
50
Q

Artifacts affect ECG by:

A
  • making it difficult to manually measure ECG cycles,
  • may cause, a false-positive on ECGs

-can be identified and corrected by MLA

51
Q

Most common artifacts:

A

muscle, wandering baseline, 60-cycle interference (alternating current artifact), interrupted baseline artifact

52
Q

if unable to correct artifacts, this may indicate a _______________.

A

broken machine

53
Q

Electrocardiography

A

non invasive recording of the electrical activity of myocardium

54
Q

electrocardiograph

A

instrument used to record the electrical activity of the heart

55
Q

electrocardiogram

A

graphic representation of the electrical activity of the heart

56
Q

What does the ECG exhibit

A

the ECG exhibits the amount of electrical activities produced by the heart at the time required for the impulse to travel through the heart

57
Q

What is the difference between Holter and ECG?

A

ECG measures the patient’s electrical activity for a brief amount of time (like 10 seconds), Holter is attached to the patient for a long time (18 hrs, 24 hrs or a week) to observe the patient’s electrical heart activity through daily activities

58
Q

Purpose of ECG:

A

evaluate the following symptoms: chest pain, shortness of breath, dizziness, heart palpitations, detect dysrhythmia, or detect cardiac ischemia.

  • diagnose myocardial infarction
  • determine presence of enlargement of the heart
  • detect myocarditis or pericarditis
  • assess effect on the heart of digitalis or other cardiac drugs
  • determine presence of electrolyte disturbances
  • detect congenital heart defects
  • assess cardiac risk during surgery
  • part of a complete examination
59
Q

cardiac ischemia

A

presence of impaired blood flow to heart muscle

60
Q

coronary artery

A

the vessel that feeds the heart muscle oxygen, if there is a block in the coronary artery it causes ischemia

61
Q

myocardial infarction (MI)

A

death of myocardial muscle cells (tissue)

62
Q

What are some downfalls of ECG?

A
  • cannot detect all cardiovascular disorders
  • ECG is taken in patient’s resting state
  • only records 10 seconds of heart’s activity
  • patient with angina pectoris doesn’t always show symptoms in a resting state
63
Q

To obtain a complete assessment of cardiac functioning, ECG must be used in combination with:

A

-patient history, patient’s health, physical exam, other tests

64
Q

MLA responsibilities for running ECG:

A

-patient preparation, operation of electrocardiograph, ID and eliminate artifacts, care and maintenance of electrocardiograph

65
Q

Is it the MLA’S duty to translate results of ECG?

A

no

66
Q

ECG machine formats:

A

single-channel format, three channel format

67
Q

structure of the heart’s layers/lining from inside to outside?

A
  1. endocardium
  2. myocardium
  3. epicardium
  4. visceral pericardium
  5. parietal pericardium
68
Q

structure of the heart’s layers/lining from outside to inside?

A
  1. parietal pericardium
  2. visceral pericardium
  3. epicardium
  4. myocardium
  5. endocardium
69
Q

What is the job of the pericardial sac?

A

to protect the heart muscle

note: it is a layer of tissue that covers the heart

70
Q

heart consists of 4 chambers:

A

upper chambers: left and right atria, lower chambers: left and right ventricles

71
Q

where does the heart receive it’s nourishment?

A

the coronary arteries

72
Q

Sinoatrial node

A

aka pacemaker of the heart, a knot of modified myocardial cells, located in upper portion of right atrium, regulates the heartbeat

73
Q

What is the order of impulses?

A
  1. SA Node
  2. AV node
  3. Bundle of His
  4. Bundle branches
  5. Purkinje network
74
Q

What happens after the Purkinje Network?

A

Contraction of the ventricles

75
Q

What does the AV node do?

A

it delays the impulse, to allow the atria to contract completely and fill with blood

76
Q

What stimulates the QRS wave?

A

the purkinje fibres

77
Q

How is the electrocardiograph paper divided?

A

into two sets of squares

  1. small square 1mm x 1mm
  2. large square 5mm x 5mm

note: each large square is made up of 25 small squares

78
Q

How do we know the ECG machine is standardized?

A

At the beginning of the test the machine automatically shows a standardized mark about 10mm in height and 2mm in width

79
Q

How does a cardiac ischemia appear on the ECG?

A

-depressed ST segment and inverted T wave

80
Q

How does a myocardial infraction appear on the ECG?

A

-larger than normal Q wave and elevates S-T segment

81
Q

Electrode

A

made of a substance that is a good conductor of electricity

-conducts impulse into machine by lead wires

82
Q

bipolar leads are aka

A

stander leads

83
Q

Normally ECG is recorded with paper moving at a speed of:

A

25 mm/second

84
Q

Minimal patient preparation for an ECG

A
  • facilitate placement of electrodes
  • ensure good adhesion of the electrodes to skin
  • instruct patient to wear comfortable clothing and not to wear lotion or oil
85
Q

Artifacts

A

additional electrical activity picked up by electrocardiograph

86
Q

Most common artifacts:

A

-muscle, wandering baseline, 60 cycle interference, interrupted baseline

87
Q

Muscle artifact

A
  • characterized by a fuzzy, irregular baseline
  • due to involuntary and voluntary muscle movement

note: if patient has a condition characterized by involuntary muscle movement, position the patient in a way that reduces movement
ie. a patient with parkinsons would be positioned with hands under buttocks with palms facing downward

88
Q

Wandering Baseline artifact

A

caused by loose electrodes, dried-out electrolyte on electrode, body creams, oils on skin, excessive movement of chest wall during respiration

-basically anything that causes the electrode not to properly adhere

89
Q

60-cycle interference artifact

A

also known as AC artifact, appears as small straight spiked lines that are consistent, causes baseline to be thick and unreadable

-due to electrical interference, dangling lead wires, other electrical equipment in room, wiring in walls, improper grounding of the ECG

90
Q

Interrupted baseline artifact

A

caused by a frayed or broken patient cable, ill-attached lead wire to alligator clip

91
Q

Holter monitor electrocardiography

A

portable ambulatory monitoring system that continuously records electrical activity for 24 hrs or more

  • detects cardiac abnormalities
  • designed so that patient is able to maintain daily activities
92
Q

purpose of holter monitor

A

used to diagnose cardiac rate, rhythm and conduction abnormalities
-frequently used to assess the rate and rhythm of the heart during daily activities for patients with unexplained chest pain

93
Q

in regards to holter monitor, MLA is responsible for:

A

preparing the patient, applying and removing the monitor, instructing patient in guidelines to follow during the monitoring period

94
Q

What can cause interference artifacts while using the holter monitor

A

magnets, metal detectors, areas with high-voltage electrical wires

95
Q

cardiac dysrhythmia

A

abnormal electrical activity in the heart causing an irregular heartbeat

96
Q

categories of cardiac dysrhythmia

A

extra beats, abnormal rhythm, abnormal heart rate

97
Q

premature atrial contraction

A

an abnormal p wave shape but with normal QRS complex and T wave

-common in healthy individuals, but can also be associated with serious atrial dysrhythmias

98
Q

Paroxysmal Supraventricular Tachycardia (PSVT)

A

abrupt episode of tachycardia, with a heart rate of 150-250, sudden onset and termination

-ECG cycles are very close together

99
Q

What does a patient experience with PSVT?

A

sudden pounding or fluttering of chest, weakness and breathlessness, acute aprehension

100
Q

Atrial Flutter

A

one of most common rhythm disorders

-rapid regular fluttering of atrium, heart rate of 250-250 bpm, more than one P wave precedes QRS complex

101
Q

How does an atrial flutter appear in the ECG?

A

p wave appears as saw toothed spikes, QRS is normal and t wave usually lost in p waves

102
Q

How does atrial fibrilation appear inECG?

A

p waves have no definite pattern or shape

103
Q

How does premature ventricular contraction appear in ECG?

A

beat comes early in a cycle, not preceded by a p wave

-wide and distorted QRS complex

Cardiovascular, ECG and Vital Signs (3 decks)

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