w10 ecg tracing

Question 1

position of ECG

Answer 1

supine, laying on back face up

Question 2

when may you not be able to get patient in supine position

Answer 2

-disability in wheelchair
-post-operative patient
-burn patient
- arthritic
you can perform ecg with patient sitting, or lying in another position. - face down or on side ** make note on req

Question 3

why limb lead placements altered

Answer 3

• amputees
• casts, splints, braces
• surgical incisions, drains
• skin lesions, rashes

Question 4

what to do with amputee patient

Answer 4

place sensor on stump, avoid areas with obvious scare tissue.

• if one leg completely gone put both on the other leg (right one grounds anyway)
• place on shoulder or hip
• • similar procedures can be done with patients with casts

Question 5

what to do if there is an obstruction where precordial sensor is to be placed?

Answer 5

• you cannot place lead, skip it and record it on requisition – which leads are missing and why
• physician may ask that the sensor be placed in another position
• placement of precordial leads is critical and shouldn’t be varied

Question 6

conditions that do not allow correct placement of chest leads

Answer 6

• post chest or thoracic surgery
• chest trauma wounds
• skin growths on chest areas
• presence of monitoring equipment
• braces over chest area
• burns to chest

Question 7

what to do with patient that has burns on chest

Answer 7

• isolation procedures adhere to intensely - susceptible[ to infection
• consult nurse to see if bandages can be removed and nurse must do this
• do not attach sensor, tip of the lead held in contact with patient skin or tissue- do one lead at a time and disinfect will

Question 8

how to know if person has dextrocardia

Answer 8

• heart on right side- classical case: mirror image
• reverserd direction of leads in lead 2, 3, aVR and aVL it will appear as tho right and left arm electrodes are reversed

Question 9

what to do if patient has dextrocardia

Answer 9

-normal leads run first and a second tracing done with additional leads on right side
V1, V2 remain same, V3-V6 are moved to right side and marked as V6R
run 1: standard positions
run 2: V1, V2, V3R, V4R, V5R, V6R

Question 10

geriatric patients disabilities

Answer 10

-hearing loss
-memory loss
-parkinsons disease
arthritis

Question 11

how to help geriatric c patient

Answer 11

-need more time- do not rush, gently and firmly prepare them for test.

Question 12

hearing impaired patient

Answer 12

face patient and speak clearly

keep explanations simple, concentrating on what you want patient to do -if deaf, write it down or use body motions

Question 13

patient with alzhiemers disease

Answer 13

confused and fight procedure, never force patient- violates their rights. -consult doctor or nurse

Question 14

patient with parkinson’s

Answer 14

uncontrolled shaking of limbs- put sensors high on libs, several tracings must be done. hands under bum

Question 15

arthritis patients

Answer 15

-can be done while patient in wheelchair, if patient can lie down, use pillow to support their arthritic joints and make the patient relax

Question 16

psychiatric patients

Answer 16

• apprehensive or disorientated due to drug therapy.
• don’t say ecg say electrocardiogram (could be confused with ECT) or say you are making a tracing of the electrical activity of the heart ** nurse or healthcare worker should be present

Question 17

oncology patient

Answer 17

may have scar tissue from radical mastectomy - treat with tact and understanding especially if recent.

• • always be prepared for the sight of a disfigured chest and be compassionate
• skin markings by felt or tattoo showing where radiation treatments being recieved- do not place lead here (could result in severe irritation)

Question 18

trauma patients

Answer 18

not relaxed-must be done quickly

• high on limbs to keep baseline steady
• discard sensors in biohazard bin
• tell patient what you are doing. (if informed they are more cooperative)

Question 19

acute myocardial infarct patient

Answer 19

• sweating (cleanse with alcohol)
• if having trouble breathing, have them sit up
• if it is the first ECG make position with pen this allows more accuracy for following ECGS, if already markings use those.

Question 20

paediatric patients

Answer 20

sternal angle (around rib 2) can’t be located so work down from space one

• cut electrodes to fit better
• right ventricle more dominant in neonate and children( may need V4 and V3 on right) -label v3r and v4r
• parent can hold child, and makes them feel safer.
• always take time to explain procedure to child and show them the tracing when its finished -make them an extra copy and share it with them - cut it into a heart so they can take it home