HEALTHSTREAM TELEMETRY & ECG EXAM 2023/2024

HEALTHSTREAM TELEMETRY & ECG EXAM 2023/2024 Mechanical & Electrical Activity - CORRECT ANSWER-- Correlation between the electrical and mechanical functions of the heart - Electrical activity stimulates the heart to contract - Electrocardiogram (ECG) show both functions - Electrical pulse= action potntial Cardiac Monitoring - CORRECT ANSWER-- Used to diagnose dysrhythmias, chamber enlargement, MI/myocardial ischemia, monitor effects of electrolyte imbalances of medication administration - Electrical activity can be monitored by an ECG lead, ambulatory, or telemetry Electrodes in continuous monitoring or telemetry - CORRECT ANSWER-- Use 2-4 electrodes - Create an imaginary line (called a lead) that serves a reference point from which the electrical activity is viewed - Lead is like an eye of a camera, it has a narrow peripheral view, looking at only the electrical activity directly in front of it Electrocardiography - CORRECT ANSWER-- The end product of which is a electrocardiogram - Can view the electrical impulse that travels through the heart - Each [hase of the cardiac cycle is reflected by specific waveforms on the screen of a cardiac monitor or on a strip of ECG graph paper (so it represents function of the hearts conduction system) ECG can show... - CORRECT ANSWER-- Ischemia - Infarction - Enlarged cardiac chambers, electrolyte imbalances - Drug toxicity Placing EKG Electrodes - CORRECT ANSWER-- 4th intercostal space to the right of sternum - 4th intercostal space to the left of sternum halfway between v2 & v4 - Left midclavicular line in the 5th ICS - Left anterior axillary line in 5th ICS - Left midaxillary line in the 5th ICS Placing Telemetry Electrodes - CORRECT ANSWER-- Place top right (RA), middle right (V), and lower right (RL) - Place top left (LA) and lower left (LL) - Clean skin and clip hair as necessary Conductivity - CORRECT ANSWER-Transmit electrical impulses across cell membranes and from cell to cell Contractility - CORRECT ANSWER-A/V muscle cells shorten fiber lengths to propel blood forward during contraction Automaticity - CORRECT ANSWER-Ability of cardiac cells to initiate an impulse (primary pacemaker cells) Excitability - CORRECT ANSWER-Ability to respond to stimulus and then depolarize Refractoriness - CORRECT ANSWER-Cells unable to respond to stimulus until recovered from previous stimulus (repolarization) Cells capable of initiating pace of heart - CORRECT ANSWER-Although the SA and AV nodes ordinarily initiate the pacing of the heart, all of the cells have the capability of doing so Depolarization - CORRECT ANSWER-- Normally negatively charged cells developing a positive charge - Produces mechanical contractions P Wave - CORRECT ANSWER-- Atrial depolarization (contraction) - SA node fired PR Interval - CORRECT ANSWER-- Beginning of P wave to the end of PR interval - Atrial depolarization - AV delay and travel time to purkinje fivers - 0.12-0.20 - 3-5 little dots QRS Complex - CORRECT ANSWER-- Ventricle depolarization (contraction) - Time required for depolarization of both ventricles - 0.04-0.10 ST Segment - CORRECT ANSWER-- Early ventricular repolarization - Should not be elevated more than 1 mm (1 line above) - Should not be depressed more than 0.5 mm below (1/2 line below) Elevated ST Segment indicates... - CORRECT ANSWER-- MI - Use STEMI or NSTEMI Depressed ST Segment indicates... - CORRECT ANSWER-Ischemia QT Interval - CORRECT ANSWER-- Ventricular depolarization and repolarization - May be prolonged with some medications & can be a dangerous sign Each box on a telemetry is how many seconds? - CORRECT ANSWER-0.2 Each small line/dot on a telemetry is how many seconds? - CORRECT ANSWER-0.04 Step 1 of Rhythm Strip Analysis - CORRECT ANSWER-- Determine regularity of R waves - Determine underlying rhythm (regular or irregular) - "March it Across) or calipers Step 2 of Rhythm Strip Analysis - CORRECT ANSWER-Calculate the ventricular rate Ways to calculate ventricular rate - CORRECT ANSWER-- 6 second method - Rule of 1500's 6 Second Method - CORRECT ANSWER-- Used with regular and irregular rhythms - Get a 6 second strip and could the number of R waves (the whole QRS must fit) - Multiply this number by 10 Rule of 1500's - CORRECT ANSWER-- *Only used for regular rhythms* - Count the # of small squares between 2 consecutive R waves and divide the number into 1500 Step 3 of Rhythm Strip Analysis - CORRECT ANSWER-- Assess the P waves - Present? - 1 P for every QRS (1:1) - Are they all the same? Step 4 of Rhythm Strip Analysis - CORRECT ANSWER-- Measure of the PR interval - Normal is 0.12-0.20 seconds - Consistent? - Pattern? Step 5 of Rhythm Strip Analysis - CORRECT ANSWER-- Measures the QRS complex - Normal is less than 0.12 seconds - Are they all the same? Normal Sinus Rhythm - CORRECT ANSWER-- Heart rate of 60-100 bpm - Regular Rhythm - Pwave before each QRS and are identical - PR interval is 0.12-.20 - QRS is less than .12 Cardiac Dysrhythmias - CORRECT ANSWER-- Heartbeat disturbances (beat formation and/or conduction) - Dysrhythmia and arrhythmia are used interchangeably - However, in reality, dysrhythmia means abnormal where as arrhythmia means absent Dysrhythmia Classification - CORRECT ANSWER-- Classified by site of origin - SA node, Atrial, AV node, or ventricular Causes of Dysrhythmias can be related to.. - CORRECT ANSWER-- Cardiac - Pulmonic - Other (disease-related, meds, lifestyle, etc.) Common causes of Dysrhythmia - CORRECT ANSWER-- HF - MI - Conduction defects - Caffeine - Electric shock - Electrolyte imbalances (K+) - Hypoxia - Acidosis - Hypoglycemia - Hypothermia - Clots - Trauma Dangers of Dysrhythmias - CORRECT ANSWER-- Potential for progression (benign or life threatening) - Hemodynamic status impact (what's it doing to cardiac output, HR X SV) - Blood clots What is a life threatening Dysrhythmia? - CORRECT ANSWER-- If decreased cardiac output and ineffective tissue perfusion - Sometimes symptoms of dysrhythmias in the older adult may be present only with increased activity Treatments of Each Dysrhythmia - CORRECT ANSWER-- Continued monitoring - Pacemaker - Cardioversion - Defibrilation - Meds What should you do for a new dysrhytmia? - CORRECT ANSWER-- Check both the pulse and the blood pressure to determine if the pt is tolerating the rhythm - Some patients lead perfectly normal lives with abnormal rhythms