Cardiovascular and Hematologic System PDF

CARDIOVASCULAR and HEMATOLOGIC SYSTEM Cardiovascular Risk Factors Modifiable Risk Factors TOBACCO HYPERTENSION-  increases risks of  is the single biggest cardiovascular disease. risk factor for stroke. It T...

CARDIOVASCULAR and HEMATOLOGIC SYSTEM Cardiovascular Risk Factors Modifiable Risk Factors TOBACCO HYPERTENSION-  increases risks of  is the single biggest cardiovascular disease. risk factor for stroke. It The risk is especially also plays a significant high if you started role in heart attacks. smoking when young, smoke heavily DIET PHYSICAL  high in saturated fat INACTIVITY increases the risk of heart disease and stroke. increases the risk of It is estimated to cause heart disease and about 31% of coronary stroke by 50% heart disease and 11% of stroke worldwide. Cardiovascular Risk Factors Modifiable Risk Factors ALCOHOL Having one to two alcohol drinks a day may lead to a 30% reduction in heart disease, but above this level alcohol consumption will damage the heart muscle. DIABETES Type2 diabetes a major risk factor for coronary heart disease and stroke. Non- Modifiable Risk Factors AGE FAMILY HISTORY Simply getting old is If a first-degree blood a risk factor for relative has had cardiovascular coronary heart disease or stroke before the age disease; risk of stroke of 55 years (for a male doubles every decade relative) or 65 years (for after age 55. a female relative) your GENDER risk increases.  Male has a greater risk of heart disease than a RACE pre-menopausal woman.  People with African But once past the or Asian ancestry are at menopause, a woman’s higher risks of risk is similar to a man’s. developing Risk of stroke is similar cardiovascular disease for men and women. than other racial groups. Laboratory and Diagnostic Procedures Samples of the patient’s blood are sent to the laboratory for the following reasons: 4. To monitor 1. To assist in making response to diagnosis therapeutic 2. To screen for risk interventions factors associated with CAD 5. To assess 3. To establish abnormalities in baseline values for the blood that initiating other affect prognosis diagnostic procedures,or therapeutic Laboratory and Diagnostic Procedures TROPONIN I and T Usually utilized for  REMEMBER to MI 1. Elevates within 3 -4 hours AVOID IM 2. Peaks in 4-24 hours injections before and persists for 7 days obtaining blood to 3 weeks sample! Early and  Normal value for late diagnosis Troponin I is less than 0.6 ng/mL can be made! Laboratory and Diagnostic Procedures LIPID PROFILE  Lipid profile measures the serum cholesterol, triglycerides and lipoprotein levels  Cholesterol= less NPO post than 200 mg/dL midnight (usually Triglycerides- 40- 150 mg/Dl 12 hours)  LDL- less than 160 mg/dL HDL- 30-70- mg/dL  Triglycerides- 100- 200 mg/dl Laboratory and Diagnostic Procedures BLOOD CHEMISTRY Lab Test and Normal Values IMPLICATIONS Blood Urea Nitrogen  End product of protein metabolism (BUN) excreted by the kidney 10- 20 mg/dl Assess renal function  Elevated BUN reflects reduced renal perfusion from decreased cardiac Creatinine output or an intravascular fluid volume 0.7 – 1.4 mg/ dl deficit as result of diuretic therapy or dehydration  Elevated BUN may mean renal impairment  A normal creatinine level and an elevated BUN suggest intravascular fluid volume deficit Laboratory and Diagnostic Procedures BLOOD CHEMISTRY Lab Test and Normal Values IMPLICATIONS Magnesium  Necessary for maintenance of 1.3- 2.3 mEq/L potassium, absorption of calcium  HYPOMAGNESEMIA- decrease magnesium level due to renal excretion from the use of diuretics. Predisposes to atrial or ventricular tachycardia  HYPERMAGNESEMIA- elevated magnesium level. Elevated level depresses contractility and excitability of the myocardium causing heart block Laboratory and Diagnostic Procedures BLOOD CHEMISTRY Lab Test and Normal Values IMPLICATIONS Potassium  Has a major role on cardiac 3.5 – 5 mEq/L electrophysiologic function  HYPOKALEMIA- decrease in potassium level due to administration of potassium excreting diuretics can cause many forms of dysrryhtmias  HYPERKALEMIA- increase level of potassium due to increase intake, decrease renal excretion of potassium, use of potassium sparing diuretics (spirinolactone). Laboratory and Diagnostic Procedures BLOOD CHEMISTRY Lab Test and Normal Values IMPLICATIONS Sodium  Do not directly affects the cardiac 135- 145 mEq/L functions  HYPERNATREMIA- indicates fluid volume excess  HYPOKALEMIA- indicates fluid volume deficit Laboratory and Diagnostic Procedures COAGULATION STUDY Lab Test and Normal Values IMPLICATIONS Partial Thromboplastin  Measures the activity of the Time (PTT) 60- 70 sec intrinsic pathway and is used to or assess the effects of Activated Partial unfractionated heparin Thromboplastin Time  Adjustment of heparin dose is (aPTT) 20- 39 seconds required for aPTT less than 50 seconds increased the dose and if more than 100seconds decrease Prothrombin Time (PT) the dose 9.5- 12 seconds  Measures the extrinsic pathway activity and is used to monitor the level of anticoagulation with Laboratory and Diagnostic Procedures HEMATOLOGIC STUDIES Lab Test and Normal Values IMPLICATIONS Complete Blood Count  Identifies the total amount of (CBC) wbc, rbc, platelet, hemoglobin and hematocrit and is carefully monitored in patients with cardiovascular disease Hematocrit Male: 42%- 52%  Represents the percentage of rbc found in 100 ml of whole blood Hemoglobin Male: 13- 18 g/dl  The RBC contains hemoglobin Female: which transports oxygen to the cells. Laboratory and Diagnostic Procedures HEMATOLOGIC STUDIES Lab Test and Normal Values IMPLICATIONS Platelet (Thrombocyte)  The first line of protection against 150, 000– 450,000/ bleeding mm3  Several medications inhibits platelet functions includes aspirin, clopidrogel (PLavix). Watch out for thrombocytopenia (low platelet count) when taking this medications  Low platelet count is called thrombocytopenia  Monitored for immunocompromised patients or White Blood Cells where there is concern for infection (Leukocytes)  An elevated WBC is called 4, 500 – 11, 000/ mm3 Leukocytosis while Leukopenia is Laboratory and Diagnostic Procedures HEMATOLOGIC STUDIES Lab Test and Normal Values IMPLICATIONS Red Blood Cell  Produced in the bone marrow and (erythrocyte) released in the blood stream as Women: 3.6 to 5.0 they mature million/mm3  Lifespan of 120 days Men: 4.2 to 5.4  Elevated RBC client may million/mm3 experience polycythemia  Decrease RBC client may experience anemia Laboratory and Diagnostic Procedures SERUM ENZYMES Lab Test and Normal Values IMPLICATIONS  Found in the heart muscles, liver Serum Glutamic and skeletal muscles Oxaloacetic  Elevated 8-12 hours after MI Transaminase (SGOT)  Peak 24- 48 hours after MI 5- 40 U/ ml  High SGOT obtained with trauma to skeletal muscles, liver disease  Used with other enzymes to more defintely define MI  Demerol and morphine may elevate the levels temporarily  Do not give IM injections before the blood tests; and if serial specimens are taken, still give no IM injections, Laboratory and Diagnostic Procedures SERUM ENZYMES Lab Test and Normal Values IMPLICATIONS Lactic Dehaydrogenase  Found in the heart, skeletal (LDH) muscles, liver, kidney, brain and rbc 150- 450 U/ml  Elevated 24- 48 hours after MI  Peak 48- 72 hours after MI  Narcotic drugs and IM injections can cause elevation of LDH.  Hemolysis can cause elevation of the LDH Laboratory and Diagnostic Procedures SERUM ENZYMES Lab Test and Normal Values IMPLICATIONS Creatine Phosphokinase Found in the heart, skeletal (CK) Creatine Kinase muscles and brain tissue Male: 5-35 ug/ml  Elevated 4- 6 hours after MI Female: 5-25 ug/ml  Peak 18- 24 hours after MI Newborn: 10- 300 iu/ml  Return to normal 3-4 days after MI  Avoid IM injection Obtain sample on time CK activity diminishes after 2 hours  Do not shake to prevent hemolysis Cardiac Stress Testing STRESS TEST Stress Test helps determine the following:  A non-invasive test 1. Presence of CAD that studies the heart 2. Cause of chest during activity and pain detects and evaluates 3. Functional CAD Exercise test, capacity of the pharmacologic test heart after MI or surgery 4. Effectiveness of anti-anginal or anti -arrythmic medications Cardiac Stress Testing EXERCISE STRESS TEST Pre- Test Stress Test 1. Consent may be Treadmill testing is the required, most commonly used adequate rest , eat a light meal stress test Used to or fast for 4 determine CAD, Chest hours and avoid pain causes, drug smoking, alcohol effects and and caffeine dysrrhythmias in 2. Instruct to wear exercise rubber shoes and clothes suitable for exercising Cardiac Stress Testing EXERCISE STRESS TEST During the Test Post- Test  The client is  Observe for 10 to monitored 15 minutes if stable  Two or more ECG may resume usual leads for heart rate, activities rhythm, BP, chest  Instruct client to pain, dyspneas, notify the physician dizziness if any chest pain,  The test is dizziness or terminated of the shortness of breath. target heart rate is  Instruct client to achieved or if the avoid taking a hot client experience shower for 10-12 any abnormalities hours after the test Cardiac Stress Testing PHARMACOLOGICAL STRESS TEST  Two vasodilating DIPYRIDAMOLE (PERSANTINE)- agents are used  Last about 15- 30 Dipyridamole minutes (Persantine) and  WOF chest Adenosine discomfort, flushing, (Adenocard) nausea and dizziness  Administered IV to ADENOSINE mimic the effects of (ADENOCARED) exercise by dilating  Last about less than 10 seconds the coronary arteries  Has similar side – effects with dipyridamole Cardiac Stress Testing PHARMACOLOGICAL STRESS TEST Nursing Interventions: 1. 4 hours fasting, avoid alcohol, caffeine Post test: report symptoms of chest pain 2. If caffeine is ingested before the test the test will have to reschedules 3. If patient is taking methylxanthines instruct the client to stop taking the medications for 24 to 48 hours. It may block the effects of dipyridamole and adenosine 4. Stress Test may take about 1 hour Echocardiography TRANSESOPHAGEAL ECHOCARDIOGRAPHY A transesophageal echocardiogram (TEE) is a diagnostic procedure that uses echocardiography to assess the heart’s function.  Echocardiography is a procedure used to assess the heart's function and structures. Transesophageal Echocardiography Transesophageal echocardiography may be performed to evaluate signs and symptoms that may suggest: 1. Atherosclerosis. A gradual clogging of the arteries over many years by fatty materials and other substances in the blood stream. 2. Cardiomyopathy. An enlargement of the heart due to thickening or weakening of the heart muscle. 3. Congenital heart disease. Defects in one or more heart structures that occur during formation of the fetus, such as a ventricular septal defect ( Transesophageal Echocardiography 4. Congestive heart failure. A condition in which the heart muscle has become weakened to an extent that blood cannot be pumped efficiently, causing fluid buildup (congestion) in the blood vessels and lungs, and edema (swelling) of the feet, ankles, and other parts of the body. 5. Aneurysm. A dilation of a part of the heart muscle or the aorta (the large artery that carries oxygenated blood out of the heart to the rest of the body), which may cause a weakness of the tissue at the site of the aneurysm. 6. Valvular heart disease. Malfunction of one or more of the heart valves that may cause an obstruction of the blood flow within the heart. Transesophageal Echocardiography CONTRAINDICATION 1. Patients with known problems of the esophagus, such as esophageal varices, esophageal obstruction, or radiation therapy to the area of the esophagus should be evaluated carefully by the doctor before having the procedure. 2. If patient is pregnant or suspect that she may be pregnant. Transesophageal Echocardiography NURSING INTERVENTIONS PRE- PROCEDURE 1. Secure Inform Consent and instruct the client about the procedure 2. NPO for 6 hours 3. Patient will be put on sedation to help him/her relax DURING THE PROCEDURE 1. Remove any jewelry or other objects that may interfere with the procedure. Also, remove dentures or any oral prosthesis. Transesophageal Echocardiography NURSING INTERVENTIONS DURING THE PROCEDURE 2. An intravenous (IV) line will be started prior to the procedure for injection of medication and to administer IV fluids. 3. The client will lie on a table or bed, positioned on left side. A pillow or wedge may be placed behind the back for support. 4. Monitor the ECG, BP, SPO2, and level of consciousness 5. The TEE probe will be passed through your mouth and down your throat. You may be asked to swallow to help pass the probe. Transesophageal Echocardiography AFTER THE PROCEDURE 1. Monitor your heart rate, ECG, blood pressure, and oxygen levels. 2. Instruct the client that throat may be sore for a few days following the procedure due to the insertion of the TEE probe. 3. Maintain on bed rest with the head of the bed elevated at 45 degrees. 4. If the gag reflex has returned offer sips of fluid, then advances to the prescribed diet. Transesophageal Echocardiography Transesophageal echocardiography may be performed to evaluate signs and symptoms that may suggest: 1. Atherosclerosis. A gradual clogging of the arteries over many years by fatty materials and other substances in the blood stream. 2. Cardiomyopathy. An enlargement of the heart due to thickening or weakening of the heart muscle. 3. Congenital heart disease. Defects in one or more heart structures that occur during formation of the fetus, such as a ventricular septal defect ( Transthoracic Echocardiogram  Is an non invasive ultrasound test that views the heart by moving a small instrument called a transducer to different locations on the chest or abdominal wall.  A transducer, which resembles a microphone, sends sound waves into the chest and picks up echos that reflect off different parts of the heart. Transthoracic Echocardiogram NURSING INTERVENTIONS PRE –TEST 1. Secure Consent and instruct the client about the procedure DURING THE TEST 1. During a TTE, client will lie on back or on left side on a bed or table. 2. Small metal discs (electrodes) will be taped to arms and legs to record heart rate during the test. 3. A small amount of gel will be rubbed on the left side of chest to help pick up the sound waves. 4. The transducer is pressed firmly against chest and moved slowly back and forth. Transthoracic Echocardiogram DURING THE TEST 5. The room is usually darkened to help the technician see the pictures on the monitor. 6. At times, client will be asked to hold very still, breathe in and out very slowly, hold breath, or lie on left side. 7. The technician will move the transducer to different areas of chest that provide specific views of heart. 8. The test usually takes from 90 minutes. Two- Dimensional Echocardiogram  This technique is used to "see" the actual motion of the heart structures.  A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart's structures can be observed.  This enables to see the various heart structures at work and evaluate them. Two- Dimensional Echocardiogram NURSING RESPONSIBILITY 1. Secure Consent and inform the client about the procedure 2. Asked to remove your clothing from the waist up. 3. A cardiac sonographer will place three electrodes (small, flat, sticky patches) on chest. The electrodes are attached to an electrocardiograph (EKG) monitor that charts the heart’s electrical activity during the test. Two- Dimensional Echocardiogram 5. The sonographer will ask the client to lie on left side on an exam table. The sonographer will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of gel on the end, which will not harm your skin. This gel helps produce clearer pictures. 6. Client may be asked to change positions several times during the exam so the sonographer can take pictures of different areas of the heart. Cardiac Catheterization  Is an invasive diagnostic procedure that in which the radiopaque arterial and venous catheters are advanced into the right and left heart.  With the aid of the flouroscopy the catheters are inseted through the blood vessels percutaneusly.  It is performed to diagnose coronary artery disease, assess coronary patency, determine the extent of atherosclorosis and vulvular heart diseases.  The site for catheter insertion is from femoral or radial artery. Cardiac Catheterization RIGHT HEART CATHETERIZATION  It involves passeges of the catheter from a femoral artery of antecubital artery into the right atrium, going to right ventricle, to pulmonary artery and pulmonary arterioles.  Pressures and oxygen saturation level are monitored from each area. Myocardial Perfusion Imaging MYOCARDIAL PERFUSION IMAGING Is used in combination with The procedure: stress testing to compare images  Position client on obtained when the heart is resting their backs with the to image the heart in a stressed arms over the head. resulting from exercise or medications.  An IV line is inserted The result of the test aids in to administer the determining if CAD is the cause of radioisotope and chest pain or other CAD related electrodes are symptoms. placed on the chest  It is commonly performed after to monitor the heart an MI attack to determine if rate and rhythm. arterial perfusion to the heart is  The procedure compromised during activity and takes approximately to evaluate the extent of myocardial damage. 30 minutes Myocardial Perfusion Imaging MYOCARDIAL PERFUSION IMAGING Results:  DEFECT: An area of the myocardium that shows no perfusion or reduced perfusion.  FIXED DEFECT: happens after an MI attack indicating that there is no perfusion in that area of the myocardium.  REVERSIBLE DEFECTS: Typically, cardiac catheterization is recommended after a positive test result to determine severity of the obstructions. Computed Tomography Scan COMPUTED TOMOGRAPHY SCANNING  Cardiovascular CT NURSING Scanning is a form of INTERVENTIONS cardiac imaging that uses  Secure consent x-rays to provide accurate  Contrast agent is used anatomic images of the  Assess for renal four chambers of the function before the heart, valves arteries, procedure. veins and pericardium.  IV hydration before and  Commonly used to after the procedure. evaluate MI perfusion or  If has history of valvular functions. hypersensitivity to  Contraindicated to contrast medium, pregnant women and administer steroids or client with renal antihistamine Positron Emission Tomography POSITRON EMISSION TOMOGRAPHY (PET)  A non- invasive NURSING INTERVENTIONS: cardiovascular  Assess client for claustrophobia imaging technique.  Radioisotopes are administered  It is used to via IV. evaluate the ff:  NPO order vary among  severity of CAD institution but blood glucose level should be in normal level. by evaluating the  Refrain from using tobacco and myocardial ingesting caffeine for 4 hours perfusion before the test.  Left ventricular  Electrodes are placed on the function and the chest to monitor heart rate and extent of rhythm. damage by MI  The test takes 90 minutes to complete Magnetic Resonance Angiography MAGNETIC RESONANCE ANGIOGRAPHY  It is a non- invasive, NURSING INTERVENTIONS: painless technique that is  The procedure is used to examine the contraindicated to client anatomic properties of with pacemaker, metal the heart. plate, prosthetic joints  The procedure uses a and other metallic powerful magnetic field implants. and computer generated  Instruct client to remove pictures to image the jewelries and other metal heart and the great items. vessels.  Position client on supine  Helps to diagnose  Assess client for problems in the aorta, claustrophobia, or may heart muscle and administer mild sedative pericardium before the procedure. The Electrocardiogram THE ELECTROCARDIOGRAM (ECG)  The electrical impulse that travels through the heart can be viewed by means of electrocardiography. The Electrocardiogram THE ELECTROCARDIOGRAM (ECG)  ECG paper is a grid where time is measured along the horizontal axis. Each small square is 1 mm in length and represents 0.04 seconds. Each larger square is 5 mm in length and represents 0.2 seconds. The Electrocardiogram THE ELECTROCARDIOGRAM (ECG)  DEPOLARIZATION: process by which the cardia muscle cells form a more negatively charge to a more positively charged intracellular state.  Occurs in the four chambers of the heart: both atria first, and then both ventricles. The sinoatrial (SA) node on the wall of the right atrium initiates depolarization in the right and left atria, causing contraction, which is symbolized by the P wave on an electrocardiogram.  When the electrical system of the heart stimulates a myocardial cell depolarization occurs resulting in the contraction of the stimulated heart muscle. The Electrocardiogram THE ELECTROCARDIOGRAM (ECG)  REPOLARIZATION: Process by which the cardiac muscle cells returns to a more negatively charge intracellular condition, their resting state.  T wave represents repolarization or recovery of the ventricles.  During repolarization there are too many Na+ ions on the inside of the cell and too many K+ on the outside of the cell. The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) SA Node - Heart pacemaker; located in the RA; initiates next step The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) P Wave: Atrial Depolarization and contraction The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) AV Node - Slows the depolarization of the atria; connects atria and ventricles electrically The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) QRS complex - ventricular depolarization; begins in Bundle of His The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) VENTRICULAR DEPOLARIZATION His Bundle Left Bundle Branch & Right Bundle Branch Purkinje Fibers The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) VENTRICULAR DEPOLARIZATION Q Wave - 1st downward wave of the complex R Wave - 1st upward wave of the complex S Wave - downward wave preceded by an upward wave The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) ST Segment Initial plateau phase of ventricular repolarization The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) T wave - Rapid phase of ventricular repolarization The Electrocardiogram THE ELECTROCARDIOGRAM (ECG) Waves -P wave -T wave -U wave Complex -QRS Segments -PR segment -ST 1 “little box” = 0.04 seconds (or 40 segment msec) Intervals 1 “big box” = 0.2 seconds (or 200 -PR interval msec) -QT interval – 5 “little boxes” = 1 “big box” Point – 5 “big boxes” = 1 second -J point The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS P WAVE:  Represents electrical impulse starting in the SA node through the atria.  Represents atrial depolarization  Is is normally 2.5 mm or less in height and 0.11 seconds or less in duration The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS QRS COMPLEX:  Represents ventricular depolarization  The Q wave is the first negative deflection after the P wave. Normally less than 0.04 seconds in duration and less than 25% of the R wave amplitude.  The R wave is the first positive deflection after the P wave  The S wave is the first negative deflection after the Rwave  When the wave is less than 5mm in height, smaller letters (q, r,s) are used. Capital letters (Q,R, S)if the wave is taller than 5mm  The QRS complex is normally less than 0.12 seconds The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS T WAVE  Represents ventricular repolarization  When the cell regains negatively charge (resting state). It follows the QRS complex The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS U WAVE  Represents repolarization of the purkinje fibers  Appears to client with hypokalemia  If present, the U wave follows the T wave and is usually smaller than the P wave. If tall may be mistaken for extra P wave The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS PR INTERVALS  Measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for the sinus node stimulation, atrial depolarization and conduction through the AV node before ventricular depolarization.  In adults, PR interval normally ranges from 0.12 to 0.20 seconds in duration. The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS ST SEGMENT  It represents early ventricular repolarization last from the end of the QRS complex to the beginning of the T wave.  The beginning of the ST segment is usually identified by a change in the thickness or angle of the terminal portion of the QRS complex. The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS QT INTERVAL  Represents total time for ventricular depolarization and repolarization.  Measured from the beginning of the QRS complex to the end of the T wave.  Usually 0.32 to 0.40 seconds in duration  Prolonged QT interval at risk for lethal ventricular dysrhythmias or torsades de pointes The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS TP INTERVAL  Is measured from the end of the T wave to the beginning of the next P wave. The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS PP INTERVAL  Is measured from the beginning of one P wave to the beginning of the next P wave.  Used to determine atrial rate and rhythm. The Electrocardiogram INTERPRETING THE ELECTROCARDIOGRAM (ECG) THE WAVES, COMPLEXES and INTERVALS RR INTERVAL  Measured from one QRS complex to the next QRS complex.  Used to determine ventricular rate and rhythm The Electrocardiogram DETERMINING THE HEART RATE Take Note:  1 minute strip contains 300 large boxes and 1500 small boxes.  Count the number of small boxes within RR interval and divide 1500 by that number.  Example: 1500 (small boxes)/ 10 small boxes between two RR waves or 1500/10+ 150 bpm The Electrocardiogram DETERMINING THE HEART RATE Take Note: For Irregular heart beat  Count the number of RR intervals in 6 seconds and multiply to 10.  The 3 seconds intervals has 15 large boxes horizontally  7 RR intervals x 10 = 70 bpm The Electrocardiogram DETERMINING THE HEART RATE RULE OF 300  Take the number of “big boxes” between neighboring QRS complexes, and divide this into 300. The result will be approximately equal to the rate  Although fast, this method only works for regular rhythms. 300/ 6= 50 BPM The Electrocardiogram DETERMINING THE HEART RATE RULE OF 300  Take the number of “big boxes” between neighboring QRS complexes, and divide this into 300. The result will be approximately equal to the rate  Although fast, this method only works for regular rhythms. 300/ =? The Electrocardiogram DETERMINING THE HEART RATE RULE OF 300 The Electrocardiogram DETERMINING THE HEART RATE 10 SECONDS RULE:  As most EKGs record 10 seconds of rhythm per page, one can simply count the number of beats present on the EKG and multiply by 6 to get the number of beats per 60 seconds.  This method works well for irregular rhythms. 33X6= 198 BPM The Electrocardiogram DETERMINING THE HEART RATE 10 SECONDS RULE:  As most EKGs record 10 seconds of rhythm per page, one can simply count the number of beats present on the EKG and multiply by 6 to get the number of beats per 60 seconds.  This method works well for irregular rhythms. The Electrocardiogram The Rhythm NORMAL SINUS RHYTHM Occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway.  Ventricular and Atrial Rate: 60 to 100 bpm in adult and regular  QRS shape and duration: usually normal  P wave: Normal and consistent, always in front of the QRS  PR interval: Consistent interval between 0.12 and 0.20 seconds  P and QRS ratio: 1:1 The Electrocardiogram The Rhythm THE DYSRYHTMIAS SINUS BRADYCARDIA Take Note: Bradycardia is SLOWER Occurs when the SA node creates an impulse at a slower than normal rate. Unstable and symptomatic bradycardia is frequently due to hypoxemia. Ventricular and Atrial Rate: Less than 60 bpm in adult Ventricular and atrial rhythm: Regular QRS shape and duration: Usually normal but may be regularly abnormal. P Wave: Normal and consistent shape, always of front of QRS complex PR Interval: Consistent interval between 0.12 and 0.20 seconds P to QRS RATIO: 1:1 The Electrocardiogram The Rhythm THE DYSRYHTMIAS SINUS BRADYCARDIA MEDICAL MANAGEMENT:  If symptomatic bradycardia (shakiness, hypotension, syncope) administer 0.5 mg of atropine via IV every 3 to 5 minutes to a maximum dose of 3 mg is the medication of choice.  Atropine blocks the vagal stimulation, thus allowing a normal rate to occur. The Electrocardiogram The Rhythm THE DYSRYHTMIAS SINUS TACHYCARDIA  Occurs when the sinus node creates an impulse at a faster than normal rate.  Causes includes: Physiological or psychological stress  Medications  Ventricular and atrial rate: Greater than 100 bpm, usually less than 120 bpm.  Ventricular and atrial rhythm: Regular  QRS Shape and duration: Usually normal but may be regularly abnormal;  P wave: Normal and consistent shape always in front of the QRS  PR Interval: Consistent interval between 0.12 and 0.20 seconds The Electrocardiogram The Rhythm THE DYSRYHTMIAS SINUS ARRYHTMIA  Occurs when the sinus node creates an impulse at an irregular rate, rhythm. The rate usually increases with inspiration and decrease when expiration.  Ventricular and atrial rate: 60 to 100 bpm, irregular  QRS Shape and duration: Usually normal but may be irregular  P Wave: Normal and consistent always infront of the QRS  PR Interval: Consistent interval between 0.12 and 0.20 seconds  P: QRS ratio: 1:1 The Electrocardiogram The Rhythm THE DYSRYHTMIAS ATRIAL FLUTTER  Occurs when there is conduction defect in the atrium and causes a rapid regular atrial rate usually between 250 to 400 bpm.  Common to client with COPD, pulmonary hypertension.  Ventricular and atria rate: Atrial rate ranges between 250 and 400 bpm ventricular rate usually 75 and 150 bpm.  Ventricular and atrial rhythm: The atrial rhythm is regular, the ventricle rhythm is regular but may be irregular.  QRS shape and duration: Usually normal but may be abnormal or absent  P wave: saw toothed shape or F waves  PR interval: Multiple f waves  P:QRS RATIO: 2:1, 3:1 or 4: 1