© 2009 The McGraw-Hill Companies, Inc. All rights reserved Electrocardiography and Pulmonary...

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Electrocardiography and Electrocardiography and Pulmonary Function TestingPulmonary Function Testing

PowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson


52-2

Learning Outcomes

52.1 Explain the conduction system of the heart.

52.2 Describe the basic patterns of an electrocardiogram (ECG).

52.3 Identify the components of an electrocardiograph and what each does.


52-3

Learning Outcomes (cont.)

52.4 Explain how to position the limb and precordial electrodes correctly.

52.5 Describe in detail how to obtain an ECG.

52.6 Identify the various types of artifacts and potential equipment problems and how to correct them.


52-4


52.7 Discuss how the ECG is interpreted.

52.8 Identify common arrhythmias.

52.9 Define exercise electrocardiography.

52.10 Explain the procedure of Holter monitoring.

52.11 Describe forced vital capacity.


52-5


52.12 Describe the procedure of performing spirometry.

52.13 Describe the procedure for obtaining a performing peak expiratory flow rate.

52.14 Describe the procedure for performing pulse oximetry testing.


52-6

Introduction Patients often have cardiovascular

or respiratory problems

Medical assistant Perform screening and/or diagnostic testing Understand the anatomy and physiology of the

heart and respiratory system


52-7

The Medical Assistant’s Role Electrocardiography

Graphic recording of the electrical impulses of the heart

Uses Evaluate symptoms of heart

disease Check effectiveness or side

effects of medications General examination


52-8

The Medical Assistant’s Role (cont.) Pulmonary function tests

Measure and evaluate a patient’s lung capacity and volume

Uses Help detect and diagnose

pulmonary problems Monitor respiratory

disorders Evaluate effectiveness of

treatments


52-9

Conduction System of the Heart Cardiac cycle

Controlled by specialized tissues in the heart wall that transmit electrical impulses

Impulses cause muscle to contract and relax


52-10

Bundle Branches

Bundle of HisSA Node

Purkinje Fibers

AV Node

Pacemaker of the heart

Sets rhythm of contractions

Bottom of right atrium

Impulse delayed slightly

Located in septum between ventricles

Relay impulse to Purkinje fibers

Located in ventricle walls

Contraction of ventricles

Conduction System of the Heart (cont.)


52-11

Electrocardiography Transmission, magnitude,

and duration of electrical impulses of the heart

Polarity Having a positive and

negative pole Resting cell

Positive outside Negative inside

Depolarization Impulse that initiates a

contraction

Repolarization Period of electrical recovery

following depolarization Prior to polarized (resting)

state



52-12

Basic pattern of the ECG Waves (deflections) are labeled P, Q, R, S, T, U



52-13

Apply Your KnowledgeTrue or False

___ The AV node is the heart’s pacemaker.

___ The medical assistant does not perform ECGs or PFTs.

___ The bundle branches relay impulses to the Purkinje fibers in the ventricles.

___ The heart is resting in the polarized state.

___ Depolarization initiates contractions of atria and ventricles.

___ Repolarization occurs before depolarization. F

ANSWER:

T

T

T

F

F

following

may

SA


52-14

The Electrocardiograph Electrical impulses are

detected through the skin Measures Amplifies – signal is

increased Records using the stylus


52-15

Types of electrocardiographs Standard machine –

12-lead, which records 12 different views at once

Single channel – one lead and records only one view

The Electrocardiograph (cont.)


52-16

Electrodes and electrolyte products Electrolyte – enhances

transmissions of electric current

Electrodes Ten areas of the body

Right and left arms Right and left legs Six locations on the chest

Enables physician to pinpoint origin of problems



52-17

Leads Provide different images of electrical activity

Marked automatically on the ECG

Limb leads Three standard – I, II, III Three augmented – AVF, AVR, AVL

Precordial leads – V1 through V6



52-18

ECG paper Single or multichannel available

Heat- and pressure-sensitive

Standardized to permit uniform

interpretation

Vertical axis – strength

of impulse (millivolt)

Horizontal axis – time

0.04 sec

5 mm(0.5 mV)

1 mm(0.1 mV)

1 mm5 mm

0.2 sec



52-19

Controls Standardization control

Speed selector – 25mm/sec standard

Sensitivity control – adjusts height of tracing

Lead selector – enables selection of a single lead

Centering control – adjusts position of stylus

Stylus temperature control – adjusts darkness of line

Marker control – on older machines

On/Off switch



52-20

Apply Your KnowledgeMatching:

___ Adjusts position of stylus A. Vertical axis

___ Adjusts height of tracing B. Sensitivity control

___ Adjusts darkness of tracing C. Precordial leads

___ Measures strength of impulse D. Horizontal axis

___ Measures time E. Limb leads

___ AVF, AVR, AVL F. Amplification

___ V1 through V6 G. Centering control

___ Increases signal H. Stylus temperature control

ANSWER:

H

G

F

E

D

C

B

A

Superbly Matched!


52-21

Preparing to Administer an ECG Proper technique essential

Preparing the room and equipment Other electrical equipment turned off Quiet room, comfortable temperature Check machine

Warm up Adequate paper


52-22

Preparing the patient

Introduce yourself

Explain the procedure

Answer questions

Ensure patient comfort

Perform ECG procedure

Preparing to Administer an ECG (cont.)


52-23

Applying the Electrodes and the Connecting Wires Electrodes – disposable

are most common

Positioning electrodes Use consistent technique Limb electrodes – place at

same level Precordial electrodes –

specific intercostal spaces Precordial Lead Placement


52-24

Attaching wires Numbers and letters

correspond to those for electrodes

Connect limb wires first Precordial in same sequence

as electrodes Avoid tension on wires

Applying the Electrodes and the Connecting Wires (cont.)


52-25

Operating the Electrocardiograph Standardize

Run the ECG Automatic Manual Multiple-channel

Check the tracing Clear / free from

artifact


52-26

Apply Your Knowledge1. In addition to making sure the room is comfortable for the

patient and the ECG machine is ready, what else should you do to prepare for performing an ECG?

ANSWER: All other electrical equipment in the room should be turned off.

2. Electrodes are placed at how many positions on the body?

ANSWER: Ten: four limb and six chest positions.


52-27

Apply Your Knowledge

3. What should you do just prior to running the ECG to see if the machine needs adjusting? What should you do upon completion of the test?

ANSWER: Standardize the electrocardiograph prior to running the tracing. Upon completion of the ECG, you should check the tracing to be sure is it clear and free from artifact.


52-28

Troubleshooting Artifacts

Causes Improper technique Poor conduction

Outside interference Improper handling


52-29

Wandering baseline – somatic interference or mechanical problems

Flat line – loose or disconnected wire

Extraneous marks – careless handling

Troubleshooting: Artifacts


52-30

Causes AC interference –

machine picks up current from other electrical equipment

Somatic interference – muscle movement

Identifying source of interference Check tracings for leads

I, II, and III

If unable to identify source, stop and notify supervisor of problem

Leave patient connected

Troubleshooting: Artifacts (cont.)


52-31

Completing the Procedure Acceptable tracing

Label properly Disconnect wires from

electrodes Remove electrodes / wipe off

electrolyte Assist patient up Prepare room appropriately

Mount tracing if necessary


52-32

Apply Your Knowledge1. What are four general causes of artifacts?

ANSWER: They are improper technique, poor conduction, outside interference, and improper handling of the tracing.

2. What should you after running an ECG?

ANSWER: After making sure the tracing is acceptable, you should label it properly, disconnect wires from electrodes, remove electrodes and wipe off electrolyte, assist patient up, and prepare the room appropriately for the next patient.

Bravo!


52-33

Interpreting the ECG Not a medical assistant

responsibility

Knowing how they are interpreted will enable you to recognize a problem requiring immediate attention

Heart rate If regular – count QRS

complexes in a 6-second strip and multiply by 10

Irregularities Conduction

abnormalities Reaction to medication


52-34

Intervals and segments Variations in length and position

Conduction disturbances Myocardial infarctions Electrolyte disturbances

Wave changes – normally similar in each lead

Interpreting the ECG (cont.)


52-35

Heart rhythm Regularity of the heartbeat

Distances between complexes and waves is normally consistent

Rhythm strip obtainedfrom lead II



52-36

Abnormal cardiac arrhythmias Irregularities in heart rhythm Ventricular fibrillation – life-threatening with no cardiac

output Premature ventricular contractions – heartbeats that

originate from the ventricles Bundle branch blocks – impulse through the heart is

slowed or blocked Atrial fibrillation – electrical disturbance in the atria and/or

AV node



52-37

Apply Your KnowledgeMatching (may be used more than once):

___ Number of QRS complexes in 6 sec x 10 A. V-fib

___ Cannot identify “P” waves B. Heart rhythm

___ Produces no cardiac output C. Bundle branch block

___ Originates in ventricles D. Atrial fibrillation

___ Slows or stops impulse E. Heart beat

___ Multiple impulses from sites outside SA node F. PVC

___ “Saw-tooth” image

___ Regularity of heart beat

___ Due to irritable of ventricular heart muscleF

F

E

D

A

A

D

C

B

ANSWER:


52-38

Exercise Electrocardiography Stress test – measures the

heart’s response to a constant or increasing workload

Uses Determine how

a diseased heart is functioning Screen a patient for heart

disease Determine patient’s ability to

start an exercise program


52-39

Ambulatory Electrocardiography Resting ECG may not show abnormalities

Holter monitoring Monitors heart over a

24-hour period of normal activity

Uses Diagnosis Evaluate status post-MI

Patient education Record activities What to avoid How to check monitor


52-40

Ambulatory Electrocardiography (cont.)

Connecting the patient 3 or 5 electrodes

Prep skin prior to placing

Tape in place to eliminate tension and ensure that electrodes stay in place for entire time of testing

Put fresh battery in the machine

Check tape

Ensure that machine is turned on


52-41

Apply Your KnowledgeWhat is the purpose for stress testing and Holter monitor testing?

ANSWER: Stress testing is used to measure the heart’s response to a constant or increasing workload. A Holter monitor is used to obtain a tracing over a period of time when a resting ECG shows no abnormalities. Both are used for diagnosing cardiac conditions or for monitoring current treatments and medications.

Correct!


52-42

Pulmonary Function Testing Evaluates lung volume

and capacity Uses

Evaluate of shortness of breath

Detect and classify of pulmonary disorders

Evaluate of effectiveness of treatments


52-43

Spirometry Measures air taken in by and

expelled by the lungs

Forced vital capacity (FVC) – greatest volume of air that can be expelled with a rapid, forced expiration

Types of spirometers: Computerized Mechanical


52-44

Performing Spirometry Technique similar for all types – be consistent

Patient preparation Inform the patient about conditions and activities that

could affect the test accuracy Explain procedure and its purpose Explain the need for a nose clip Be sure patient forms a tight seal around the mouthpiece Position the patient properly Demonstrate correct procedure


52-45

Performing the maneuver

Urge patient to blow hard and to continue

blowing

Provide feedback on performance

Obtain three acceptable maneuvers

Observe the patient’s symptoms

Notify physician immediately if symptoms occur

Performing Spirometry (cont.)


52-46

Determining effectiveness of medications

Perform test before patient takes medication for day

Repeat after patient takes the medication

Special considerations

Uncooperative patients

Patients who do not understand

Patients who cannot follow directions

Patients who cannot perform the procedure



52-47

Calibration Daily – keep logbook Calibration syringe –

standardized measuring instrument

Detect leaks – check time/volume graph

Results Evaluate ventilatory function Screening for pulmonary disorders Severity of problems Response to therapy or medication

Infection control Clean equipment after each

patient Discard disposable supplies

appropriately Wash hands before and after

each use



52-48

Peak Expiratory Flow Rate Determines amount of

air that can be quickly forced from the lungs

Peak flow meter

Reveals narrowing of airways before an asthma attack

Peak flow zones Different for each

patient Green zone – good

control of asthma Yellow zone – large

airways are beginning to narrow

Red zone – medical emergency


52-49

Pulse Oximetry Testing Non-invasive measurement of the oxygen saturation

in arterial blood Hemoglobin absorbs infrared light Measures amount of light absorbed Hypoxemia – less than 95%

Uses Pulmonary and cardiac conditions Post-operatively Sleep apnea


52-50

Apply Your Knowledge

1. What is the purpose of PFTs?

ANSWER: To evaluate lung volume and capacity.

2. What is FVC?

ANSWER: It is forced vital capacity: the greatest volume of air that can be expelled with a rapid, forced expiration. It is the measurement of the volume of air expelled and amount of time taken to expel it.


52-51

Apply Your Knowledge3. Joey Jackson called to ask about taking his asthma medicine. He said he

as been using his peak flow meter and the readings have been in his yellow zone. What do you tell him?

ANSWER: This means that his large airways are beginning to narrow and that he should take his medication as prescribed.

4. Joey decided to come to the office and you check his oxygen saturation with the pulse oximeter. The reading was 93%. What does this mean and what should you do?

ANSWER: Joey is hypoxemic. You need to notify the physician and document findings.

YIPPEE!4 for 4


52-52

In Summary ECG and PFTs – vital to diagnosis and

treatment of cardiac and pulmonary disease

Medical assistant Understanding of anatomy and physiology of both

systems Accurate performance of procedures Recognition of abnormalities Patient education


52-53

End of Chapter

As the arteries grow hard, the

heart grows soft.

~ H. L. Mencken

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Electrocardiography and Pulmonary...

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Transcript of © 2009 The McGraw-Hill Companies, Inc. All rights reserved Electrocardiography and Pulmonary...