Question

1 In your down words, list the steps to measuring a telemetry strip. Include the nomal ranges expected for specific meaurements 2 A clint is requesting more education about the risk for stroke with atrial fibrillation. la your own woeds, how would you describe the reason for increased stroke risk with this dysrhythmia, symptoms for the client to monitor for and preventative measures?

Answer 1

1. Steps for measuring telemetry strip are :-

Step 1: Calculate rate.

Step 2: Determine regularity.

Step 3: Assess the P waves.

Step 4: Determine PR interval.

Step 5: Determine QRS duration.

#. Step 1: Calculate rate.

Describe the 2 options to do so.

Option 1

Count the # of R waves in a 6 second rhythm strip, then multiply by 10.

Reminder: all rhythm strips in the Modules are 6 seconds in length.

Option 2

Find a R wave that lands on or next to a bold line.

Count the # of large boxes to the next R wave. If the second R wave is 1 large box away the rate is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes - 75, etc. (cont)

Normal - 60-100bpm

#. Step 2: Determine regularity

"Do the R's march out?"

Look at the R-R distances (using a caliper or markings on paper).

Regular (are they equidistant apart)? Occasionally irregular? Regularly irregular? Irregularly irregular?

Normal - regular

#. Step 3: Assess the P waves

P wave is the atrial depolarization where R and L atria contract

Are there P waves?

Do the P waves all look alike? Note there will be slight variation bc the heart is organ not a machine.

Do the P waves occur at a regular rate? Use caliper.

Is there one P wave before each QRS(Ventricular depolarization)?

Interpretation? This shows that there is atrial depol followed by ventricular depol a HALLMARK of a normal heart rhythm.

Normal P waves with 1 P wave for every QRS

#. Step 4: Determine PR interval

Does the progression of atrial and ventricular depolarization occur with in a normal physiological time range?

Normal: 0.12 - 0.20 seconds. (3 - 5 boxes)

#. Step 5: QRS duration

Is it within the normal physiologic time range?

Normal: 0.04 - 0.12 seconds.

2. Increased risk of stroke are :-

High blood pressure. High blood pressure is the main risk factor for stroke.

Diabetes.

Heart diseases like dysrhythmia ,blocks etc

Smoking.

Age and gender.

Race and ethnicity.

Personal or family history of stroke or TIA.

Brain aneurysms or arteriovenous malformation

Symptoms to be monitored are :-

Sudden numbness or weakness in the face, arm or leg (especially on one side of the body).

Sudden confusion or trouble speaking or understanding speech.

Sudden vision problems in one or both eyes.

Sudden difficulty walking or dizziness, loss of balance or problems with coordination.

Severe headache with no known cause.

3. The ECG interpretation is a ventricular tachycardia

Sign and symptoms of ventricular tachycardia include :-

- chest pain

- SOB

- shock

- pulmonary congestion

- congestive heart failure

- MI

4. When assisting with external defibrillation or cardioversion, the nurse should remember these key points:

Multifunction conductor pads or paddles are used, with a conducting medium between the paddles and the skin in the proper locations.

The conducting medium is available as a sheet, gel, or paste.

*Gels or pastes with poor electrical conductivity (e.g., ultrasound gel) should not be used.

*Paddles or pads should be placed so that they do not touch the patient's clothing or bed linen and are not near medication patches or in the direct flow of oxygen.

Women with large breasts should have the left pad or paddle placed underneath or lateral to the left breast.

*During cardioversion, the monitor leads must be attached to the patient in order to set the defibrillator to the synchronized mode ("in sync").

*If defibrillating, the defibrillator must not be in the synchronized mode (most machines default to the "not-sync" mode).

When using paddles, 20-25 lb of pressure must be used in order to ensure good skin contact.

When using a manual discharge device, it must not be charged until it is ready to shock; then thumbs and fingers must be kept off the discharge buttons until paddles or pads are on the chest and ready to deliver the electrical charge.

*When it is time to defibrillate, whomever is delivering the charge should announce, "charging to (number of joules)" prior to discharging.

*"Clear!" must be called three times before discharging:

As "Clear" is called the first time, the discharger must visually check that he or she is not touching the patient, bed, or equipment;

*as "Clear" is called the second time, the discharger must visually check that no one else is touching the bed, the patient, or equipment, including the endotracheal tube or adjuncts;

*and as "Clear" is called the third time, the discharger must perform a final visual check to ensure that everyone is clear of the patient and anything touching the patient.

The delivered energy and resulting rhythm are recorded.

*Cardiopulmonary resuscitation (CPR) is immediately resumed after the defibrillation charge is delivered, if appropriate, starting with chest compressions.

If CPR is warranted, after five cycles (about 2 minutes) of CPR, the cardiac rhythm is checked again and another shock is delivered, if warranted.

A vasoactive or antiarrhythmic medication is given as soon as possible after the rhythm check to facilitate a positive response to defibrillation.

After the event is complete, the skin under the pads or paddles is inspected for burns; if any are detected, the primary provider or a wound care nurse is consulted about appropriate treatment.

The defibrillator is plugged back into an outlet, and supplies are restocked as needed.