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Dysrhythmias
Disorders of formation or conduction (or both) of
electrical impulses within heart
Can cause disturbances of
Rate
Rhythm
Both rate and rhythm
Potentially can alter blood flow and cause hemodynamic
changes
Diagnosed by analysis of electrographic waveform
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
P wave
QRS complex
T wave
Types of ECG
ECG Interpretation
U wave
PR interval
ST segment
QT interval
TP interval
PP interval
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Question
The nurse is preparing a male patient to have a 12-lead
ECG performed. When prepping the skin the nurse notices
that the patient has abundant chest hair. What is the most
appropriate nursing intervention to improve adhesion of the
ECG leads?
A.Use alcohol swabs to cleans the skin before applying the
leads.
B.Clip the chest hair with the patients permission before
applying the leads.
C.Apply the leads to the arms and legs only.
D.Reschedule the ECG.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. Clip the chest hair with the patients permission before
applying the leads.
Rationale: Alcohol should not be used to prep the skin
because it increases the skins electrical impedance,
thereby hindering the detection of the cardiac electrical
signal. Clipping the hair would provide access to the
skin to assist with adhesion. The ECG would not be
performed correctly if the leads were only placed on the
extremities, and there is no need to reschedule the ECG
at this time.
Pacemakers
Electronic device that provides electrical stimuli to heart
muscle
Types
Permanent
Temporary
NASPE-BPEG code for pacemaker function
Transcutaneous Pacemaker
ICD (contd)
Safety Measures
Ensure good contact between skin, pads, and paddles
Use conductive medium, 20 to 25 pounds of pressure
Place paddles so they do not touch bedding or clothing
and are not near medication patches or oxygen flow
If cardioverting, turn synchronizer on
If defibrillating, turn synchronizer off
Question
What must a patient with an automatic ICD do?
A.Continue to go through metal-detection devices at the
airport
B.Call for assistance when blood pressure increases
C.Document events that trigger a shock sensation
D.Be compliant with all of the above-listed interventions
Answer
C. Document events that trigger a shock sensation
Rationale: The patient with an automatic ICD must
document events that trigger a shock sensation. The
patient must avoid magnetic fields such as metaldetection devices at the airport and should call for
emergency assistance when feeling dizzy.