Download Slide 1 - Lancaster City Schools

ADVANCED CARDIAC
MONITORING
HEALTH TECH 2
LANCASTER HIGH SCHOOL
Objectives
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Identify the structures of the heart.
Compare and contrast the pulmonary and systemic circulation.
Trace the pathway of the blood.
Describe coronary circulation.
Explain the cardiac cycle.
Identify what takes place during systole and diastole phases.
Define the qualities of the heart and their relationship to the cardiac
conduction system.
Describe the parts and function of the conduction system.
Explain the conduction system as it relates to the ECG.
Discuss the electrical stimulation of the heart as it relates to the ECG
waveform.
Identify each part of the ECG waveform.
Describe the heart activity that produces the ECG waveform.
Identify parts of the waveform
Explain the nursing assistants role
Return demonstrate the application of a 12-lead ECG
Chapter 2
2
The Cardiovascular System
• Anatomy of the Heart
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Center of chest
Under the sternum and between the lungs
About the size of your fist
Weighs about 10.6 oz or 300 grams
Average beats per minute = 72
Total output = 5 liters per minute
Chapter 2
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Heart Layers
Pericardial Space
Parietal Pericardium
Endocardium
Myocardium
Epicardium
(Visceral Pericardium)
Chapter 2
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Heart Chambers
Left Atrium
Right Atrium
Left Ventricle
Right Ventricle
Chapter 2
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Heart Valves and Vessels
Aorta
Tricuspid Valve
Vena Cava
Bicuspid Valve
Pulmonary Artery
Aortic Valve
Pulmonary Veins
Pulmonary Valve
Chapter 2
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Pulmonary Circulation
• Deoxygenated blood enters the right atrium
from the superior and inferior vena cava.
• From the right atrium, blood passes through
the tricuspid valve to the right ventricle.
• Right ventricle pumps the blood through the
pulmonary semilunar valve into the
pulmonary artery then to the lungs.
• From the lungs, pulmonary veins transport
the blood to the left atrium.
Chapter 2
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Systemic Circulation
• Oxygenated blood enters the left atrium,
passes through the mitral valve into the left
ventricle.
• Left ventricle pumps blood through aortic
semilunar valve to aorta.
• From aorta, blood circulates throughout the
body.
• Deoxygenated blood from the body returns to
the heart via the superior and inferior vena
cava.
Chapter 2
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Coronary Circulation
• Oxygenated blood from left ventricle, to the
aorta, to the coronary arteries
• Left main coronary artery
– Has more branches than right main since left side
of heart is more muscular
• Deoxygenated blood returns to right atrium
via coronary veins and coronary sinus.
Chapter 2
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Chapter 2
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Unique Qualities of the Heart
• Automaticity - heart’s ability to initiate
electrical impulse
• Conductivity - ability of myocardial cells to
receive and conduct electrical impulses
• Contractivity - ability of the heart muscle to
shorten in response to electrical impulse
• Excitability - ability of the heart to respond to
impulse or stimulus
Chapter 2
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Diastole – Relaxation Phase
• Blood returns to the heart via superior and
inferior vena cava.
• Blood flows from the right atrium through the
tricuspid valve into the right ventricle.
• Blood from the pulmonary veins flows from
the left atrium through the mitral valve into the
left ventricle.
Chapter 2
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Systole - Contraction Phase
• Contraction creates pressure, opening the
pulmonary and aortic valves.
• Blood from the right ventricle flows to the
lungs.
• Blood from the left ventricle flows through the
aorta to the body.
Chapter 2
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Pathways for Conduction
• Sinoatrial (SA) node
– Located in upper right portion of right atrium
– Initiates the heartbeat
– Pacemaker of the heart (60 - 100 beats per
minute)
– Normal conduction begins in SA node
Chapter 2
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Pathways for Conduction (Cont’d)
• Bundle of His (AV bundle)
– Located next to the AV node
– Transfers electrical impulse from atria to ventricles
via bundle branches
Chapter 2
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Pathways for Conduction (Cont’d)
• Atrioventricular (AV) node
– Located on floor of right atrium
– Causes delay in electrical impulse
– Can act as pacemaker if SA node is not working
(40 - 60 bpm)
Chapter 2
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Pathways for Conduction (Cont’d)
• Purkinje fibers (network)
– Electrical pathway for each cardiac cell
– Activate left and right ventricles simultaneously
– Produce an electrical wave
Chapter 2
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ECG Waveform
• ECG waveform
– Recorded activity of depolarization and
repolarization
– Isoelectric line - baseline when no electrical
activity occurs
– Discovered by Einthoven
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ECG Waveform (Cont’d)
• P wave
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First deflection
Positive
Occurs when atria depolarize
Small, compared to other ECG waves
Chapter 2
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ECG Waveform (Cont’d)
• Q wave
– Represents conduction of impulse down
interventricular septum
– Negative deflection
– Less than 1/4 the height of R wave
Chapter 2
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ECG Waveform (Cont’d)
• R wave
– First positive wave of QRS complex
– Represents conduction of electrical impulse to left
ventricle
– Usually easiest to find
Chapter 2
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ECG Waveform (Cont’d)
• S wave
– First negative deflection after R wave
– Represents conduction of electrical impulse
through both ventricles
Chapter 2
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ECG Waveform (Cont’d)
• T wave
– Represents ventricular repolarization
– Normal T wave is in same direction as QRS
complex and P wave
Chapter 2
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THE NURSING ASSISTANTS ROLE
• Recognizing and reporting abnormalities
1.The waveform
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Longer PR interval
ST interval changes
No return to the baseline between QRS and T wave
Increase in size of the T wave
New dsyrhythmia
THE NURSING ASSISTANTS ROLE
2. The Patient
– unconsciousness
– c/o
• chest pain
• SOB
• Dizziness
• Setting up continuous monitoring
• Obtaining a 12-lead ECG
DYSRHYSTHMIAS
• When electrical impulse doesn’t travel in
orderly manner through the conduction
system.
• 6 types based on where the change in
impluse or interruption occurs
DYSRHYTHMIAS
• SA Node
– Occur when impulses are fired at a rate faster or
slower than normal.
• Sinus bradycardia
• Sinus tachycardia
(sinus rhythm is the 60-100)
DYSRHYTHMIAS
• Atrial
– Impluses begin in the atria rather than the SA
node
• Atrial flutter
• Atrial fibrillation
Dysrhythmias
• Atrioventricular Junction
– Begin in the area around the av node and the
bundle of his (AV junction)
• Junctional rhythm
• Atrioventricular nodal re-entry tachycardia
DYSRHYTHMIAS
• Ventricular dysrhythmias
– Begin in the ventricles below the bundle of His
causing the blood to not circulate through the
body.
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Premature ventricular contraction
Ventricular tachycardia
Ventricular fibrillation
Idioventricular rhythm
DYSRHYTHMIAS
• Atriaventricular Blocks
– Problem with the av node that prevent the impluse
from the sa node from traveling town to the
ventricles.
• First degree
– Sent but at a slower rate
• Second degree
– Some impluses are conducted
• Third degree
– No impulse is conducted
DYSRHYTHMIAS
• Bundle branch block
– When the bundle branch is unable to conduct the
impluse down to the purkinje fibers
Automatic Blood Pressure Monitoring
Observations to Report to the Nurse
Immediately
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sterile dressing covering the insertion site is loose, wet, or soiled
redness, swelling, drainage, or bleeding at the insertion site
blood in the tubing
tubing is disconnected
a change in the position of the patient or the bed (in other words, the
transducer needs to be leveled and zeroed)
a change in the waveform or pressure reading on the monitor
complains of pain, numbness, or tingling in the hand
patient’s hand is pale, blue, or cold
Telemetry