Richie Roy L.

Bagtasos BSN IV - B ELECTROCARDIOGRAM (ECG)

Even though there continues to be new technologies developed for the diagnostic evaluation of patients with cardiovascular disease, the electrocardiogram (ECG) retains its central role. The ECG is the most important test for interpretation of the cardiac rhythm, conduction system abnormalities, and for the detection of myocardial ischemia. The ECG is also of great value in the evaluation of other types of cardiac abnormalities including valvular heart disease, cardiomyopathy, pericarditis, and hypertensive disease. Finally, the ECG can be used to monitor drug treatment (specifically antiarrhythmic therapy) and to detect metabolic disturbances. 5 Key Points An ECG is a recording of the electrical activity of the heart. 12-lead or continual ECG monitoring can be performed. ECGs can highlight changes in a patients condition and aid diagnosis. The conduction of the hearts electrical impulses is detected through the skin by electrodes placed at specific points and displayed as a graphic waveform on an ECG machine or cardiac monitor. A flatline ECG trace is often caused by a lead or electrode becoming disconnected. Patients on continual ECG monitoring should be nursed in high observation areas where alarms are easily heard.

ECG Monitoring Process Before starting ECG monitoring, informed consent must be obtained. Good contact between the electrode and the skin is essential so the skin should be clean and dry. If excess hair is present, a small patch can be shaved or trimmed with the patients consent. Skin oil and grease can be removed by rubbing the skin with alcohol or gauze (Navas, 2003). Electrodes are then attached to the patient according to the manufacturers instructions. There are several configurations for electrode positions, including three-, five- and 10-lead set-ups. A standard three bipolar lead configuration is most commonly used for continual ECG monitoring. Bipolar lead monitoring can be used to track heart rate, observe basic arrhythmias, and to detect ventricular fibrillation (Drew et al, 2004). Electrode pads are placed below the right clavicle, the left clavicle and the left lower rib cage. The red cable is connected to the right clavicle electrode, the yellow cable is connected to the left clavicle electrode, and the green cable is connected to the lower ribcage electrode.

Normal Results Normal test results include: Heart rate: 60 to 100 beats per minute Heart rhythm: consistent and even

What Abnormal Results Mean Abnormal ECG results may be a sign of: Damage or changes to the heart muscle Changes in the amount of sodium or potassium in the blood Congenital heart defect Enlargement of the heart Fluid or swelling in the sac around the heart Inflammation of the heart (myocarditis) Past or current heart attack Poor blood supply to the heart arteries Abnormal heart rhythms (arrhythmias)

How to Prepare for the Test Make sure your health care provider knows about all the medications you are taking, as some can interfere with test results. How the Test Will Feel An ECG is painless. No electricity is sent through the body. The electrodes may feel cold when first applied. In rare cases, some people may develop a rash or irritation where the patches were placed. Why the Test is Performed An ECG is used to measure: Any damage to the heart How fast your heart is beating and whether it is beating normally The effects of drugs or devices used to control the heart (such as a pacemaker) The size and position of your heart chambers

An ECG is usually the first test done to determine whether a person has heart disease. Your doctor may order this test if: You have chest pain or palpitations You are scheduled for surgery You have had heart problems in the past You have a strong history of heart disease in the family There is no reason for healthy people to have yearly ECG tests.

Principles on decision making utilizing nursing process Utilizing nursing process in decision making includes: Information Processing Subsequent research using information processing theory examines how doctors and nurses reason when making judgements and decision.

Four stage process: Cue acquisition (Assessment)

Hypothesis generation (Planning) Cue interpretation Hypothesis evaluation (Implementation) (Evaluation)

Intuition and the role of expertise Despite the variations in definition, there are commonalties in that intuition is perceived to be a process of reasoning that just happens, that cannot be explained and that is not rational. Intuition Understanding without rationale; knowledge of fact or truth as a whole; immediate knowing of something without the conscious use of reason. The Cognitive continuum This theory suggests that reasoning is neither purely intuitive nor purely analytical: that it is located at some point in between. According to the cognitive continuum theory, the major determinants of whether a practitioner utilises a rational or intuitive approach to decision making are primarily determined by the position of the decision task on a continuum. The most appropriate cognitive mode to use for the task in hand depends on three factors: the structure of the task, the number of information cues and the time available to make the judgement or decisions. Personal and professional growth Nursing has also been developing its own internal links between research and professional activity. The relationship between knowledge and decision making has been a crucial element of nursings attempt to increase its professional status. A number of commentators point to the requirement for professional occupations to possess and develop a relatively esoteric body of knowledge as the basis for practice. How a professional group uses this knowledge determines its position as a profession. MacDonald (1995) suggests that for nursing in particular the interface between nursings knowledge base and practice is characterised by three constraining factors on nursing attaining full professional status: the nature of nursing knowledge itself, indeterminacy in application and a lack of objectivity in practice.