COLLEGE OF NURSING

MADURAI MEDICAL COLLEGE, MADURAI-20

PROCEDURE DEMONSTRATION ON

ELECTROCAR
DIOGRAM

SUBMITTED TO SUBMITTED BY:

S.MAHALAKSHMI
MRS. J .ALAMELU MANGAI.M.Sc[N].,MBA[HM]. M.SC NURSING 1ST YR
NURSING TUTOR Gr – II . MADURAI MEDICAL COLLEGE
MRS. N .RAJALAXMI.M.Sc[N]., MADURAI 20
NURSING TUTOR Gr - II
COLLEGE OF NURSING,
MADURAI MEDICAL COLLEGE,

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MADURAI-20

PLACE : COLLEGE OF NURSING, MADURAI MEDICAL COLLEGE, MADURAI-20.

NAME OF THE SUBJECT : ADVANCE-NURSING PRACTICE

GROUP OF STUDENTS : B.Sc (N) II YEAR

TOPIC : ELECTROCARDIOGRAM

DATE : 09 -12-2015

TIME :

METHOD OF TEACHING : LECTURE CUM DISCUSSION

TEACHING AIDS : BLACK BOARD, PPT, CHART, ROLLER BOARD,

NAME OF THE STUDENT

TEACHER : S.MAHALAKSHMI

PLACEMENT : M.Sc (N) - I YEAR

NAME OF THE GUIDE CUM

EVALUATOR : Mrs. J .ALAMELU MANGAI M.Sc (N).,MBA [HM].,

MRS. N .RAJALAXMI. M.Sc[N].,

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 Nursing Tutor Gr – II.

CENTRAL OBJECTIVE

The student will acquire knowledge on “electrocardiogram” develop desirable attitude in doing the

procedure and practice these stills in the wards.

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CONTRIBUTORY OBJECTIVES
The student will be able to

1. Define electrocardiogram
2. Explain about conduction system of heart
3. List down the medical uses of ECG
4. Enlist the articles used for ECG
5. Explain the purposes of ECG
6. Describe the procedure of ECG

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INTRODUCTION:
Electrocardiogram is one of the most useful diagnostic procedure in emergency
medicine.it is an easy and inexpensive test that is used routinely in the assessment of patients with chest pain.to
avoid misinterpretation the clinician must have a systemic approach. The corner stone for making the diagnosis of
cardiac ischemia and is used for making decisions about eligibility for thrombolytic therapy.

S.No TIME SPECIFIC CONTENT TEACHERS LISTENER AV EVALU

OBJECTIVES ACTIVITY S AIDS ATION
ACTIVITY

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 3M define ECG Definition: Lecture Listening Blac Define
1 TS Electrocardiography (ECG in k ECG
boar
British English[1] and EKG in American
d
English[2][3]*) is the process of recording
the electrical activity of the heart over a
period of time using electrodes placed on
a patient's body. These electrodes detect
the tiny electrical changes on the skin
that arise from the heart muscle
depolarizing during each heartbeat. The
graph of voltage versus time produced by
this noninvasive medical procedure is
referred to as
an electrocardiogram(abbreviated ECG 
or EKG).

explain the Listening Pow

2. conduction DISCUSSIO and asking er
system of NORMAL CONDUCTION SYSTEM N questions point
heart. OF HEART:
During each heartbeat, a healthy Explai
heart will have an orderly progression of n the
depolarization that starts with pacemaker conduc
cells in the sinoatrial node, spreads out tion
through the atrium, passes through system
of
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 the atrioventricular node down into heart
thebundle of His and into the Purkinje
Interacting
fibers spreading down and to the left
3. with student
throughout the ventricles. This orderly
List down teacher Pow List
the medical pattern of depolarization gives rise to the er down
uses. characteristic ECG tracing. Lecture cum point the
discussion medica
l uses
Medical use:/PURPOSES:
Reasons for performing
electrocardiography include:

 Suspected heart attack
 Suspected pulmonary embolism
 A third heart sound, fourth heart
sound, a cardiac murmur[14] or other
findings to suggest structural heart
disease
 Perceived cardiac dysrhythmias[14]
 Fainting or collapse[14]
 Seizures[14]
4  Monitoring the effects of a heart
medication
Enlist the  Assessing severity of electrolyte Interaction
articles used abnormalities, such as hyperkalemia
in Discussion
procedure. Char
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 ARTICLES: t
Enlist
 ECG machine the
 Electrodes for 12 lead ECG articles
used in
 Electro conductive gel proced
5 Explain the  Front open gown or shirt for ure.
purposes of patient Listening
ECG.
 Tissue paper Lecture
Pow
er
PURPOSES:
point
 IT is the most important signal tool
for the diagnosis of arrhythmias. Explai
 It is helpful to study the cardiac n the
functions purpos
es of
 It helps in diagnose cardiac disease ECG
 It helps to detect electrolytes
imbalance hyperkalemia
 To give valuable diagnostic
information about cardiac function
 To confirm the coronary heart
disease in most cases
 To demonstrate cardiac arrhythmias
such as ventricular tachycardia and

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 heart block.
COMPONENTS OF ECG:
 Wave or complex
 Segment
 Interval
 Time duration
ELECTROCARDIAGRAM
GRAPH SHEET:
 IT is divided into small squares
light lines and large squares by
heavier lines
 Horizontal lines measures the
amplitude one small square
represents 1mm and large squares
represents 5mm
 The vertical lines measure time
each small square represents 0.20
sec.
HEART RATE:
 NORMAL HEART RATE IS 60
TO 100 beats /minute.less than 60
means brady cardia.more than 100
means tachycardia.

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  The heart rate per minute is equal
to the number of large squares
between the R waves divided
inton300.
Rhythm:
 Atrial rhythm measures about the
distance between the two
consecutive p-waves.(pp interval)
 Ventricular rhythm measures the
distance between the two
consecutive R waves(RRinterval)
Axis :
 Axis refers to the direction of
depolarization, which spreads
throughtout the heart to stimulate
the myocardium to contract.
 Normal axis is defined as lead 1
positive and AVF lead positive.left
axis deviation defines as lead 1
positive and AVF lead negative.
 Right axis deviation defines as
lead 1 negative and avf lead
positive.
12 LEAD ECG:

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Electrocardiogram consists of record
from 12 leads:
 The 3 standard bipolar
leads(I,II,III)
 The 3 unipolar limb
leads(AVF,AVR,AVL)
 The 6 unipolar chest leads(v1-v6)
 Lead I-right arm-left arm
 Lead II-right arm-lefft leg
 Lead III left arm- left leg
 AVR-Right arm
 AVF-left foot
 AVL-left arm
 V1-4th intercostal space at right
sternal border
 V2 -4th left intercostal space at left
sternal border
 V3-midway between v2 and v4
 V4-5th left intercostal space at mid
clavicular line
 V5-5th left intercostal space at
anterior axillary line

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 V6-5th left intercostal space at mid
axillary line
CAUSES OF ABNORMAL ECG
PATTERN:
 Skeletal muscle activity or
movement of the patient.
 Loose electrodes
 Damaged or broken wires
 Improper connections
 Improper placement of electrodes
 Electrical interference.

PRE PROCEDURE CARE:

 Check and arrange the ECG
machine , cables, electrodes and
needed articles ready in advance.
 Explain the procedure clearly to the
patient and family
 Check the doctors order for the
ECG
 Identity the patient name, age ,id no
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 ,and diagnosis
 Inform the patient not to move
during procedure.

Procedure

Nurses action Rationale

Lecture cum
1.explain the 1. helps to gain discussion
purpose of ecg and patients co-
procedure to the operation and
patient that reduces anxiety.

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 prodedure is safe
6.
and painless. 2.procedure
2.ask the female requires placement
patients to remove of electrodes over
all tightings chest area.
EXPLAIN clothing around
ABOUT the chest.
THE
3.ensure the ecg
PROCEDU
monitor is is in
RE
functioning order.
4.ensure proper 4.ensures a precise
standardization of recording of ECG.
machine.
5.rigid posture and
5.ask the patient to contraction of
lie in supine muscles may result
position and be as in artifacts on ECG
relaxed as record.
possible.
6.exposing chest
6.Provide privacy area ,which is
by pulling the embarrassing for
curtains around the the patient.
patient.
7.expose the chest
completely .apply
electromagnetic
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gel on lead
placement sites
and position all
electrodes
appropriately.
a. check for color
codes of limb leads
and connect limb
electrodes to all
four extremities as
per the
manufacturers
code.
b.place the suction
electrodes at
appropriate sites.
7. proper contact
c. ensure proper between the skin
contact between and electrodes and
the lead and proper placement
skin.shaving of the of electrodes are
chest may be essential for
required in case of obtaining a good
male patients. recording.
8.instruct the 8. patient
patient that you are movement during

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going to start the recording causes
recording and he artifacts on
/she could lie still ECGrecord.
in the bed without
moving till the
recording
complete.
9. record the ECG
by manual
recording.
Automatic
recording. 10.in case of
inappropriate
10. check the ECG
recording or
record for
presence of
appropriateness
artifacts, recording
and presence of
needs to be
artifacts if any.
repeated.
11. remove
electrodes from all
four limbs and
chest.wipe off the
electroconductive
gel using tissue
papers.
14.label the ECG: 14.provide

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 a. write patients accurate
name ,date , and identification data.
time of recording.
15. read and report 15. helps to
the ECG as identify obvious
follows: gross
a. rhythm abnormalities.
b. conduction
intervals
c. cardiac axis
d. a description of
the QRS complex,
ST segments and T
waves.
16. show ECG
record to the
physician as soon
as possible so that
further treatment
orders can be
obtained if any.

AFTER CARE:
 Clean the patients electrode site
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 with gauze or tissue paper.
 Ambulate and transfer the patient
send the ECG record to doctor for
interpretation.
 Replace the ECG machine and
articles to the proper place.
 Record and report in the nurses
sheet.

NURSES RESPONSIBILITIES:

 Nurses working in coronary care

unit and intensive care unit should
know to operate the ecg machine.
 Nurses should able to interpret and
identify the dysrhythmia.
 Nurses should understand about
the dysfunctions and loose
connections.
 Nurses working in coronary care
unit are responsible in ECG
interpretation and treating with
appropriate life saving method as
per institutional protocol.

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SUMMARY:

So for we have discussed about the ECG, uses about leads, procedure, and nurses responsibility.

CONCLUSION:

Thus the ECG is an instrument ,which detects very small electrical signals ,generated by the depolarization and
repolarization of the myocardium.it is the useful procedure done for every patient .

BIBLIOGRAPHY:

 Annamma Jacob, Clinical Nursing Procedures, Second Edition, Jaypee Publication (2010). PP: 501 - 523
 Mansukh.B.Patel - Ward Procedures Fourth Edition, Elsevier Publication PP: 285 - 301
 Shakunthala Sharma, Principles And Practice Of Nursing, Second Edition, Jaypee Publication, PP: 9 - 31
 Frank.M.Pierson, Principles And Techniques Of Patient Care, Third Edition, Saunders Publication PP: 83 –
91
 Sr. Nancy, “Principles An Practice Of Nursing” Senior Nursing Procedure, Fourth Edition, (2006), N.R.
Publishing House, Indore – Pge No.374 & 375

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