Obtaining an ECG P and P and slides

Question 1

what represents atrial depolarization + contraction eg QRS, P wave, PR interval

Answer 1

PR interval

Question 2

what represents V depol + contraction

Answer 2

• QRS interval represents V depol + contraction

Question 3

t or f

the ECG reflects muscular work of the heart

Answer 3

f it monitors the regularity and path of the electrical impulse through the conduction system

Question 4

when might an ECG be used

Answer 4

• Used to monitor effects of meds, recovery of MI, or when chest pain occurs..preop baseline, prediagnostic baseline

Question 5

what is a dysrhythmia

Answer 5

• Dysrhythmia = any deviation from NSR (normal sinus rhythm) – result from ischemia, valvularabn, anxiety, drug toxicity, A-B imbalance

Question 6

which of the following are dysrhythmias
tachycardia, 
bradycardia, 
premature ventricular or atrial contractions (PVC, PACs), 
AFib, 
heart block

Answer 6

all dysrhythmias

Question 7

in a 12 lead ECG how many leads and electrodes are there and where are they in gen

any specific terms for the location

Answer 7

• 12 lead ECG includes bipolar limb leads I, II, II; augmented limb leads aVr, aVl, aVf and precordial chest leads V1 to V6
• ‘Precordial’ refers to the electrodes on the chest

Question 8

what is a lead (in reference to ECG)

what can it show yo

a lead is like a _____

Answer 8

Leads refer to the tracing of the voltage between the electrodes on the ECG printout.

• Each lead specific to different part of the heart to help detect where damage has occurred

a lead is like a camera

Question 9

what is the term for the electrodes on the chest

Answer 9

• ‘Precordial’ refers to the electrodes on the chest

Question 10

is a 12 lead or 3-5 lead used in emerg or for interpretive results

when else is this used

Answer 10

• 3 or 5 lead considered interpretive – used during emerg + pacemaker insertion. One electrode substituted sequentially for the 6 chest electrodes

Question 11

t or f a 12 lead ECG is considered diagnostic

Answer 11

t

Question 12

what is a holter monitor and what kind of data can it gather over what period of time

Answer 12

• Holter monitor used for continuous ECG over long period of time (small, portable, records for up to 24hrs)

Question 13

which lead is most commonly used for interpretation and what area of the heart does it show

Answer 13

lead II

Lead II (Camera II) shows us the inferior aspect of the heart. (this looks at the larger more muscular areas of the heart

Question 14

when might they focus on another lead for interpretation

Answer 14

• the pt will always have one lead that is represented all across the paper. It is not always lead II at the bottom. If the patient had something wrong with another area of their heart they might putthat one at the bottom

Question 15

what does it mean to have a positive inflection on the ECG

why are there neg or pos inflections

Answer 15

• the electrodes are like batteries. One is neg and one is pos. if moving towards the pos electrode it will have pos inflection…
If the current moves away from the positive electrode, you will see an inverted waveform

Question 16

what kind of lead would a patient be on if they were on telemetry

Answer 16

gen 5 lead

Question 17

what woud you call a dysrhtyhmia that is…

Normal repsosne to exercise, emotion, pain, fever, hyperthyroidism + ceratin drugs

Answer 17

sinus tachycardia

Question 18

what characteristics does a sinus bradycardia have

how might the pt present

Answer 18

Regular rhythm, rate <60bpm
Normal P, PR interval, and QRS complex

Assoc w decreased CO, dizziness, syncope, chest pain

Question 19

Irregular rhythm followed by compensatory pause

what kind of rhtyhm is this
what causes it

Answer 19

Premature Ventricular Contractions (PVCs)

Caused by irritable focus; if more than 6 beats/min or pairs, indicated inc ventricular irritability

Question 20

ventricular tachy
what is the clinical significance of this

rate?
P wave char
PR char
QRS char

Answer 20

Often a forerunner of V ib; may cause dec CO b/c dec V filling time

Rhythm slightly irregular; rate 100-200
P wave absent, PR interval absent, QRS wide and bizarre

Question 21

assessment before applying ECG

what position ill they be in

Answer 21

• Verify type of ECG ordered

* Pt’s ability to follow directions, remain still in supine

Question 22

what can pt NOT do when you are applying the electodes

if they dont listen/cant follow what happens to results

Answer 22

Instruct pt to lie still w/o talking (12 lead only) and do not cross legs (movement produces artefact + skews results)

Question 23

how do you prep the skin and site for application of electrodes

Answer 23

Clean + prep skin: wipe sites w EtOH (removes oil), clip hair if necessary.

Question 24

why might proper application of electrodes be challening on emaciated pt

Answer 24

Difficult to do if pt emaciated d/t bony structures + no subcut fat

Question 25

when applying the electrodes and leads where do you press and why

Answer 25

8) Apply self-sticking electrode, being careful to apply P on perimeter only. Attach leads. (P on center of lead displaces displaces gel + results in poor tracing)

Question 26

where to place the limb leads? is proximal or more distal better?

best to be right on the bone to stabilize it?

Answer 26

g. One lead on each extremity. Place on lower portion of each extremity, avoiding any bony prominences
i. aVr – right wrist
ii. aVl – left wrist
iii. aVf – left ankle
iv. aV7 – right ankle

• limb leads should be near wrists and ankles but avoid the bony prominences. Just make sure in same spot bilaterally

Question 27

not sure we need to know the placement

Answer 27

a. V1 – fourth intercostal space (ICS) at right sternal border
b. V2 – fourth ICS at left sternal border
c. V3 midway between V2 and V4
d. V4 – fifth ICS at midclavicular line
e. V5 – left anterior axillary line at level of V4 horizontally
f. V6 – L midaxillary line at level of V4 horizontally

Question 28

not sure we need to know these

which are the lateral leads and what do they look at

Answer 28

Lateral leads (I, aVL, V5and V6 ) Look at the electrical activity from the vantage point of thelateralwall of leftventricle

Question 29

which are the septal leads and what do they look at

Answer 29

Septal leads (V1and V2) Look at electrical activity from the vantage point of theseptalsurface of the heart (interventricular septum)

Question 30

wich are the anterior leads and what do they show

Answer 30

Anterior leads (V3and V4) Look at electrical activity from the vantage point of theanteriorwall of the right and left ventricles (Sternocostal surface of heart)

Question 31

once the pt is all hooked up what do you need to do

what subjective thing do you need to document during the tracing

Answer 31

9) Turn on ECG, enter required demographic info into computer + obtain tracing
a. Simultaneous 12-channel recording: enter pt name + MRN into ECG menu. Obtain test tracing. Reposition leads as needed. Activate machine to obtain simulatnaoeus tracing of all 12 leads. If pt experiences !chest pain!, document on ECG printout (pain often correlated to arrhythmia on ECG)

Question 32

dont think we need to know

how to get 3 or 5 lead recording

Answer 32

b. 3 or 5 Lead Recording: after placing limb electrodes, apply gel over V1 to V6 locations.
- Turn lead selector to leads ‘1’, turn on machine + begin recording. If tracing clear, run sequential 6 second tracings for leads I, II, III, aVr, aVl + aVf by turning lead selector to corresponding settings.
- Stop machine, position V electrode over V1 position, and run 6 sec tracing. Repeat by moving V electrode over V2, V3 etc…

Question 33

if serial tracings are expected what might the cardiologist ask you to do

Answer 33

mark where they were placed for consistency

Question 34

what to record and report after obtaining ECG

Answer 34

• When ECG was obtained (date + time) and where tracing was sent, rationale for obtaining ECG (pain, discomfort, before or after sx), and baseline VS. Include rhythm strip in pt chart
• Report any arrhythmias or chest pain to HCP immediately

Question 35

if ECG cannot be interpreted b;c of absence of tracing in one or more leads; presence of electrical artifact in tracing what do you do?

Answer 35

Inspect electrodes
Reposition any leads that move as result of pt breathing or movment or vibrations in environment + repeat tracing
Remind pt who moves that it is necessary to lie still
If artifact looks like 60-cycle interferences (very thick-lined waveform) unplug battery-operated equipment in room oneat time to see if interference disappears (note: 60-cycle interferene is rare)

Question 36

your pt is getting sweaty but youre afraid of changing the results by reapplying the electrodes what should you do

Answer 36

you need to reapply as sweat will affect the readings

Question 37

your pt has chest pain or anxiety during ECG what to do

Answer 37

Continue to monitor
Reassess factors contributing to anxiety
Follow specific postoperative orders r/t findings
Notify HCP

Question 38

if 5 lead placement where do you put the electrodes

the upper ones
the lower ones
V1

helpful way to remember the colors

Answer 38

Upper electrodes placed just below clavicles,
Lower electrodes placed at lower edge of ribcage
V1 4th intercostal space to R of sternum

White goes to upper R-white is like a cloud and clouds are over grass. Green goes under ribcage on r. smoke over fire. Brown for heart

Question 39

is positioning of 5 lead different when doing continuous and telemetry readings

Answer 39

Same positioning used whether continuous monitoring via bedside monitor or using telemetry pack