Cpms College of Nursing: Assignment ON Electrocardiogram (ECG)

CPMS COLLEGE OF
NURSING
ASSIGNMENT
ON
ELECTROCARDIOGRAM
(ECG)
DATED: 10th June, 2021

SUBJECT: CHILD HEALTH NURSING
SUBMITTED TO SUBMITTED BY:

MAAM ARCHANA DAS AMY LALRINGHLUANI
ASSOCIATE PROFESSOR M.Sc. (N) 1ST YEAR
M.Sc. (N) CHILD HEALTH NURSING CPMS CON
CPMS CON
INTRODUCTION
The electrocardiogram (ECG or EKG) is a diagnostic tool that is routinely used to assess the
electrical and muscular functions of the heart.
The SA node initiates each heart beat by discharging an electrical impulse. As this electrical
impulse spreads over the atria and ventricles, the atria contracts and is followed by
ventricular contraction. As the wave of contraction passes off, atrium and ventricles relax
(repolarization). This process normally takes place with each heart beat (80—120 times per
minute).
DEFINITION
Electrocardiogram is a graphic record of the electrical impulses that are generated by external
surface of the body where they are detected by electrodes and measured by galvanometer
INDICATIONS
 Screening for congenital or acquired heart disease.
 Follow-up of established cardiac disorders:
- Progression of chamber enlargement.
- Hypertrophy.
- Conduction disorders.
- Ischemic changes.
 Evaluation of apparent life-threatening event, syncope, chest pain, or new-onset
seizure.
 Arrhythmia detection and evaluation.
 Evaluation of conduction disorder.
 Monitoring cardiac effects of medication.
 Evaluation for appropriate pacemaker or defibrillator function.
 Evaluation of cardiac effects of electrolyte or metabolic abnormalities.
CONTRAINDICATIONS
 Disorders that limit access to skin of chest wall, such as thoracic wound.
 Extensive bandages over chest.
 Third-degree skin burns.
EQUIPMENT
 ECG machine, leads.
 Electrode stickers; pediatric patches are best.
 Alcohol pads to clean skin.
RISKS
 Improper electrical grounding may deliver electrical shock; extremely rare.
PATIENT PREPARATION
 Clean the area with alcohol swab.
 Skin must be clean and dry.
 Leads cannot be placed over bandages: either reposition bandage or omit lead.
PATIENT POSITIONING
 Supine position is essential.
 Some patients have T wave changes in upright positions, and decubitus positioning
may slightly alter the location of the heart relative to the ECG leads.
PLACEMENT OF LEADS
RA: Right forearm, distal to insertion of deltoid muscle.
LA: Left forearm, distal to insertion of deltoid muscle.
RL: Right leg.
LL: Left leg.
V1: Fourth intercostal space, right sternal edge.
V2: Fourth intercostal space, left sternal edge.
V3: Halfway between V2 and V4.
V4: Fifth intercostal space, midclavicular line.
V5: Same level as V4 on anterior axillary line.
V6: Same level as V4 on midaxillary line.
PROCEDURE
Sl no Procedure Rationale
Obtaining Cart and Entering Patient Information
1 Obtain device from designated storage
location and bring to patient bedside.
2 Perform hand hygiene Routine Infection Control Practices reduces
transmission of microorganisms.
3 Turn device on by depressing the on/off Turning the device on and off between
button located on the keyboard. patients prevents the previous patient’s
information from being attached to the
current patient
4 Identify patient using two patient Failure to correctly identify patient prior to
identifiers. procedures may result in error.
5 Explain procedure to patient and/or family. Reduces patient’s and/or family’s anxiety
which promotes relaxation and improves
ECG quality
6 Enter the patient data into the ECG Accurate patient demographics ensure the
machine. ECG results are correctly interpreted.
Preparing Patient and Lead Placement
1 Promote relaxation. Patient must be Encouraging family involvement may
cooperative and non-restrained during the facilitate relaxation.
procedure The use of “facilitating tucking” by family
or health care provider is recommended.
Only touch after patient or caregiver
permission granted or saying ‘excuse my
touch’.
2 Patient positioning This is facilitated by nurses and/or parents
- Place patient in the supine or semi- depending upon the age of the patient.
fowlers position. This reduces muscle tremor artifact by
- Ensure arms are placed down along relaxing muscles in the arms, shoulders and
both sides of patient neck.
- Ensure patient’s legs and hips are
relaxed, not crossed or tilted
- Ensure the patient is still and the
tracing is stable on the monitor of the
ECG machine.
3 Prepare skin for lead placement. Ensures leads will adhere to the skin
- Dry diaphoretic skin using a sterile throughout the test.
gauze Leads will adhere better if hair is “pushed”
- Ensure skin is free of oils using a gauze to either side. Shaving the skin free of hair
and sterile water. Alcohol swabs may may be necessary in rare circumstances.
be used if necessary.
- Separate skin hairs if applicable
4 Attach leads to the patient using the
appropriate Lead Placement, with careful
attention to limb lead placement.
Performing the test
1 Observe the acquisition screen tracing for ECG systems show heart rhythms in 10
normal/abnormal readings for 30 – 60 second tracing increments. Waiting 30-60
seconds. seconds allows the user to see abnormal
heart rhythms and more effectively use the
ECG as a risk screening tool.
2 Press ECG located on the right side of the Effort and time should be taken to capture
keyboard. The captured tracing will be tracings with heart beat irregularities. If no
displayed for review. irregularities are noted a normal, artifact free
tracing should be captured.
3 Review captured tracing and assess for
signal quality and presence of signal
artifact.
4 SELECT CONTINUE if the displayed IMPORTANT: Only Select CONTINUE for
tracing is sufficient to provide to the ECGs that are of sufficient quality to
ordering physician. provide to the Ordering Physician and
OR include in the Patient Health Record.
SELECT CANCEL if the displayed tracing Additional ECGs should only be attained if
is insufficient to provide to the ordering there is a value added, clinical need to
physician. The displayed tracing will revert capture multiple time-points (eg. sudden
to the real time acquisition screen. Restart change in rhythm, arrhythmia detection,
the acquisition process at OBSERVE physician request, etc.)
above.
5 Remove ECG wires from electrode Always remove stickers gently (possibly
stickers and ECG stickers from patient. using an adhesive remover for dry skin) to
ensure the patient is not left with a negative
experience.
Ask older patients if they would prefer to
take the stickers off themselves.
6 Turn device off by depressing the on/off Turning the device on and off between
button located on the keyboard. patients prevents the previous patient’s
information from being attached to the
current patient
7 Return device to its designated storage Ensure unit is turned off, screen is folded
location. down and system is plugged into outlet.
COMPLICATIONS
 Rare.
 Incorrect set-up or equipment malfunction may result in an ECG that is
misinterpreted, resulting in additional (unnecessary) testing.
FOLLOW-UP
 Depends on the reason the test was obtained, the patients’ clinical status, and the ECG
findings.
 Patients with abnormal ECGs should be referred to a pediatric cardiologist; the timing
of referral depends on both the ECG finding and the clinical context.

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What are the main steps involved in performing an ECG?

What are the important considerations for patient preparation and positioning?

CPMS COLLEGE OF

DATED: 10th June, 2021

SUBMITTED TO SUBMITTED BY:

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