Question

Active Learning Template: Diagnostic Procedure

ATI Ch. 28

Electrocardiography and Dysrhythmia Monitoring: Medical Emergencies

Diagnostic Procedure

description of procedure

Indications

Nursing Interventions

outcomes/evaluation

client education

potiential complications

nursing interventions due to the “potiential complications

Answer 1

Description of procedure

ECG is a graphic tracing of the electrical impulses produced in the heart.Tjhe procedure is as follows.

• Perform hand hygiene.
• Assemble necessary supplies.
• Attach and plug in the power cord.
• Verify that the machine is operational and positioned properly.
• Identify,interview and instruct the patient on the procedure.
• Offer female patients gowns to be worn with the opening down the front.
• Prepare the electrode sites and attach the electrodes.Limb electrodes should be applied over the fleshy part of the inner aspects of the lower legs and on the upper part of the forearms.
• Connect the patient cable.
• Instruct the patient to relax,breathe normally and refrain from speaking.
• Standardize the machine
• Adjust the stylus to the cente r of the paper.
• record and mark the leads if necessary
• Remove the sensors;wipe electrolyte from the patients skin,if used.
• Politely dismiss the patient,aiding the patient in getting up and dressed ,if necessary.
• perform hand hygiene
• Clean the machine,straps and sensors according to manufacturers instructions.
• Mount the ECG if necessary and transfer patient informtion.
• Chart the procedure in the patients record and sign it.

Indications

• Myocardial infarction.
• Ischaemia
• Stroke
• conduction related cardiac issues.

Nursing interventions

• When assessing the cardiac rhythm make an accurate interpretation and immediately evaluate the consequences of the findings for the individual patient.
• Assessment of the patients haemodynamic response to any change in rythm is essential as it will guide the selection of therapeutic interventions.
• Certain dysrythmias maybe a result of electrolyte disturbances and may lead to a life-threatening dysrythmia.At all times,the patient,not the monitor must be assessed and treated.

Evaluation

Dysrhythmias occurs as the result of various abnormalities and disease states.When assessing a cardiac rythm ,a systematic approach should be used.A recommended approah includes

• Note the P wave.is it upright or inverted?
• Evaluate the artial rythm.
• Calculate atrial rate.
• Measure the duration of PR interval.
• Evaluate the ventricular rythm
• Calculate the ventricular rate.
• Measure the duration of the QRS complex.
• Assess the ST segment
• Measure the duration of QT interval

.Potential complications

• Irregular rate
• Decreased or increased BP
• Decreased O2 saturation.
• Dizziness ,syncope.
• Dyspnea
• Extreme restlessness,anxiety
• Feeling of impending doom.
• numbness ,tingling of arms.
• Weakness and fatigue.
• Cold clammy skin.
• Diaphoresis.
• Pallor
• Palpitations.

Nursing interventions to potential complications

• Ensure patent airway.
• Administer oxygen via nasal cannula
• Obtain baseline vital signs.
• Initiate continious ECG monitoring.
• Identify underlying rythm
• Identify dysrhythmia.
• Establish IV acess.