M1P5.pdf

1/9/24, 1:03 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9a… Analyzing the Electrocardiogram Rhythm Strip The ECG rhythm strip must be analyzed in a systematic manner to determine the patient’s cardiac rate and rhythm, an...

1/9/24, 1:03 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9a… Analyzing the Electrocardiogram Rhythm Strip The ECG rhythm strip must be analyzed in a systematic manner to determine the patient’s cardiac rate and rhythm, and to detect arrhythmias and conduction disorders, as well as evidence of myocardial ischemia, injury, and infarction. Determining Heart Rate from the Electrocardiogram Heart rate can be obtained from the ECG rhythm strip by several methods. A 1-minute rhythm strip contains 300 large boxes and 1500 small boxes. Therefore, an easy and accurate method of determining heart rate with a regular rhythm is to count the number of small boxes within an RR interval and divide 1500 by that number. If, for example, there are 10 small boxes between two R waves, the heart rate is 1500/10, or 150 bpm; if there are 25 small boxes, the heart rate is 1500/25, or 60 bpm (see Fig. 22-4). An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The top of the ECG paper is usually marked at 3-second intervals, which is 15 large boxes horizontally. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. Most cardiac monitoring has functionality that includes the ability to continuously monitor the rhythm and alert health care personnel with an auditory and visual alarm when a clinically significant change in the rhythm occurs. However, a high rate of triggered, clinically insignificant alarms may lead to alarm fatigue, which has been linked to nurses ignoring, disabling, or silencing alarms (Sendelbach & Jepsen, 2018)—putting patients at increased risk of adverse events. Quality and Safety Nursing Alert It is vital that the nurse assesses the cause(s) of a cardiac monitor’s alarm and then adjusts the alarm default settings and individualizes the alarm parameter limits an an evaluation and discussion with the primary provider to validate that the patient needs to remain on continuous cardiac monitoring. Normal Sinus Rhythm Electrical conduction that begins in the SA node generates a sinus 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. Normal sinus rhythm has the following characteristics: https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9aojXmGqF3r… 1/3 1/9/24, 1:03 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9a… Ventricular and atrial rate: 60 to 100 bpm in the adult 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 P:QRS ratio: 1:1 Normal sinus rhythm is generally indicative of good cardiovascular health. However, an increase of 10 bpm or more in the resting heart rate increases the risk for sudden cardiac death, atrial fibrillation, heart failure, coronary artery disease, stroke, and cardiovascular disease (Aune, Sen, ó’Hartaigh, et al., 2017). Example Youtube: EKG/ECG Interpretation (Basic): Easy and Simple! Summary EKG/ECG, simply known as electrocardiogram, is a pictorial representation of the heart's electrical conduction. It is a structure that allows the user or reader to examine changes in the heart structure for the purpose of identifying a myriad of cardiac disease processes. Knowing how the ECG/EKG works is important for nurses and medical practitioners. If the ECG/EKG instrument is read and interpreted properly, it can detect cardiac problems and other related issues very early. The EKG academy (https://ekg.academy/ekg-waveform-lesson) gives a visual breakdown for the components of an EKG waveform. Review What’s a normal adult heart rate? Normal = 60 – 100 bpm Tachycardia > 100 bpm Bradycardia < 60 bpm The twelve leads show the electrical current through the heart from different planes. Think of each lead as a different snapshot of the heart to be interpreted. Keeping this in mind will help interpret what is being seen and identify which areas of the heart may be “hurting” or have damage. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9aojXmGqF3r… 2/3 1/9/24, 1:03 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9a… A normal heart rhythm contains a P wave, a QRS, and a T wave. Knowing the normal amplitude, deflection, and duration of each component is essential to accurate rhythm and EKG interpretation. Amplitude measures the voltage of the beat and is determined by how high the wave reaches as measured by each square vertically on the chart (10 mm = 1 mv.; 5 squares = .5 mV; 2.5 squares = .25 mV). Deflection is determined by which lead on the patient it is coming from. Duration is determined by how long it is as measured by squares going horizontal. The PR Interval indicates atrioventricular conduction time. The interval is measured from where the P wave begins until the beginning of the QRS complex. The QRS complex indicates ventricular depolarization. The QRS interval is measured from the end of the PR interval to the end of the S wave. The QT interval indicates ventricular activity: both depolarization and repolarization. It is calculated measuring the QT interval from the beginning of the QRS complex to the end of the T wave. The ST segment traces the early part of ventricular repolarization. The ST segment begins at the end of the QRS complex and continues to the beginning of the T wave. Youtube: ECG for Beginners. Understanding the waves of ECG, P wave, QRS complex. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9aojXmGqF3r… 3/3