unit 4 big test Flashcards
what starts the pumping of the heart muscle
electrical activity
what causes the electrical current in the heart muscle
chemical changes in the cells of the heart
what is the state of a resting cell
negative charge
what is the mechanical response to depolarization (cell turns positive)
systole
why type of electrode is only used for a short time
resting
when would you chose monitoring electrodes over resting electrodes
when the electrodes must stay on the patient longer
what is telemetry used for
ongoing mobile monitoring in a hospital setting
how many leads are used in telemetry
5
what is a holter monitor used for
ongoing mobile monitoring outside of an inpatient setting
what is continuous monitoring used for
ER, ICU, or bedside monitoring without movement
how many leads are viewed in continuous monitoring
3-5
what is a 12 lead EKG used for
evaluating heart rhythm and signs of heart diease
what is a stress test used for
evaluating for heart disease when heart rate is increased
how many leads are used in a stress test
12
which electrode is positive and negative in lead 1
LT arm positive, RT arm negative
which electrode is positive and negative in lead 2
LT leg positive, right arm negative
which electrode is positive and negative in lead 3
left leg, left arm
what is positive and negative in the augmented leads
in each lead a different limb is positive, the negative is always the central terminal
what are the positive electrodes in aVR, aVL, and aVF
right arm, left arm, and the leg left
what are the precordial leads
v1-v9
what is the negative in the precordial leads
the central terminal
which leads look at the inferior wall of the heart (right coronary artery)
lead 2, lead 3, and aVF
which leads look at the anterior wall of the heart (left anterior descending)
v1, v2, v3, v4
which leads look at the left lateral wall (circumflex)
lead 1, aVL, v5 and v6
what is the default speed of EKG paper
25 mm/sec
what is the default gain (sensitivity) of EKG
10 mm/minivolt
what happens if you speed up the tracing of EKG paper. when you you do so?
the waves spread out. this is used for fast rhythms.
what happens if you increase the gain of EKG tracing? when would you do so?
the waves become taller. when waves are hard to identify
when would you decrease the gain (make waves shorter)
if they are overlapping vertically
what are the colors of lead 1, 2, and 3
white, red, and black (white on right, smoke over fire)
what color is v1 and the one below it (RL)?
brown and green (dirt over grass below the clouds)
how should a patient be positioned for an EKG
laying down (supine or semi-fowlers)
what do you need to examine tracing for when an EKG is complete
clear tracing and fix issues before removing wires. check for signs of dangerous arrhythmias
who removes wires from patient? who removes electrodes?
the EKG tech, the patient
If the patient needs multiple EKGs can you leave the electrodes in place?
check the package, it will tell you if they can be reused
what equipment is necessary for applying telemetry?
a pack with batteries, lead wires, electrodes (monitoring style), towel, clippers, instructions
how are the steps for applying a telemetry pack similar and different from applying a 12 lead EKG?
they use the same skin prep and placement of leads on the torso. they are different in the amount of wires used, the patient must carry a transmitter with telemetry, the amount of time they are used for, and telemetry requires patient teaching
what are stress tests used for
checking heart function, future heart problems, planning for a heart procedure, routine screenings, family history, and heart surgery follow-ups
how is stress induced during a stress test
exercise or injection of medication that increases HR
how is a nuclear stress test special
it is done in addition to a normal stress test and it provides brain imaging to see where blood is not flowing
how is the patient positioned during a nuclear stress test?
they are laying down with arms above head
when is the imaging for a nuclear stress test done
before and after the plain stress test
how many hours before a stress test must a patient avoid caffine?
24, potentially 48
how long before a stress test should a patient be NPO
3 hours
what must patients bring with them to the test
all of their medications
what should patients avoid before a stress test
beta blockers
how long do stress tests normally last?
2-4 hours
when is the first 12 lead EKG done during a stress test
3 EKGS are done before the exercise portion. one laying, one standing, and one hyperventilating
how often are vital signs recorded during a stress test
following Bruce’s protocol, every 2-3 minutes, and always prior to an increase in incline or speed
what is a requirement for the the stress test to be valid
patient’s HR must reach 85% of their maximum heart rate zone
what training besides an EKG cert is required to perform a stress test?
CPR certification
what equipment is necessary to have in a stress testing facility
a crash cart, electrodes, clippers, towel, BP cuff, pulse ox monitor, oxygen
what symptoms require you to stop a stress test
dizziness, SOB, chest pain, increase in systole BP greater than 10 mmHg, decrease in systolic BP greater than 10 mmHg, systolic BP greater than 250 mmHg, diastolic BP greater than 115 mmHg, leg cramps, severe diaphoresis, worsening arrhythmias, patient asks to stop, rate does not go above 120
when can an EKG tech stop monitoring a patient after a stress test is complete
vitals are checked every 5 minutes until the 15 minute mark. tech can stop monitoring when vital signs return to baseline
how long does a holter monitor record activity for
24-48 hours
how must you prepare the skin for holter monitoring
clean with soap and water, abrade
what should be sent home with a patient that is having holter monitoring
monitoring equipment with batteries, medical tape, a journal
what should a patient do if their electrode becomes loose or falls off
notify their office and retape
what must a patient document when they are using a holter monitor
anything that might change HR< medications, activities, symptoms
when would patients push the event button
when they feel concerning symptoms
why would a physician order an event monitor
to log activity for longer than a holter monitor. EMs can track for 1-2 weeks.
how are looping event monitors different from nonlooping
looping event monitors constantly record, while nonlooping do not record anything leading up to an event
what is the purpose of a stress loop
to give slack to the wire so the electrode can withstand more tug
where is a nonlooping event monitor placed when patients have symptoms
directly over the heart
which laws protect the privacy of protected health information
HIPAA, and HITECH
how should you position a patient with orthpnea
semi-fowlers or high-fowlers
what cant a pregnant women be positioned laying down
we must keep pressure off the vessels tracing to the fetus
how should you position a woman who is 6+ months pregnant during an EKG
semi-fowlers, propped on the left side
if you can not place the electrodes on the correct spots on the chest, where should you place them
as close to their normal location as possible
what are the locations of v7, v8, and v9
left posterior MAL, middle of left scapula, left vertebral border
why would a posterior lead EKG be done
to view the back of the heart or to view the right atrium
why are pediatric electrodes moved
the heart is tilted to the right in ages 2-12
if a person has an injury, large breasts, or implanted devices where electrodes should be placed, how should you place them
move to the closest location that is not impacted by these.
what types of artifact are always caused by environment
broken recording an electrical interference
what can you do to reduce electrical interference
remove devices from proximity, unplug unnecessary equipment, do not use extension cords,
what is dextrocardia
when the heart points to the right rather than the left
what might cause artifact
temperature, faulty equipment, the patient
what types of artifact are caused by muscle action
somatic tremor and wandering baseline
choppy distortion throughout tracing indicates which artifact
somatic tremor
how can you reduce artifact from tremors
place hands under butt, move leads to torso, increase temp or room/give blanket, encourage deep and slow breathing (if patient is nervous)
what is a normal activity that may cause wandering baseline
breathing
how can you adjust electrodes if breathing is causing artifact
place the leads on the limbs rather than the chest
what can cause wandering baseline
bad contact with skin, breathing, patient moved
what causes broken recording artifact
wires or electrodes are loose, broken wires
how do you treat broken recording artifact
check the electrodes in leads that you are seeing the pattern, replace
what is the pre stage of hypertension
elevated bp, 120-120 systolic and less than 80
what is the first stage of hypertension
stage 1 130-139 systolic or diastolic 80-89
what is the the second stage of hypertension
systolic greater than 140 or diastolic greater than 90
what is a hypertensive crisis
systolic over 180, diastolic over 120
