University of the Philippines Manila The Health Sciences Center COLLEGE OF NURSING Sotejo Hall, Pedro Gil Street,

Ermita, Manila 1000

ECG Interpretation Exercise Insights and Highlights

Submitted in partial fulfillment Of the requirements in N-109.1: Nursing Interventions III-A

Prepared by: Kerima Danica Lising Gayo 2010-60152 N109.1 Group B

Submitted to: Prof. Ina G. Ragotero, RN, MAN, DDM Clinical Instructor University of the Philippines College of Nursing

October 7, 2013

ECG Interpretation Exercise Patients Name: Martirez, Romeo Macalinao Is there a P wave? Is the rhythm regular? What is the heart rate/ min? What is the P-R interval? What is the QRS duration? What is the QT interval? Describe the ST segment interpretation. What is your interpretation? Normal Sinus rhythm, with isoelectric ST segments; It is often a sign of myocardial ischemia, of which coronary insufficiency is a major cause. Other causes may be subendocardial ischemia or even, non Q-wave myocardial infarction, reciprocal changes in acute Q-wave myocardial infarction Assess pain location, duration, radiation, occurrence, a new phenomenon. Review of previous activities that cause chest pain. Create a 12 lead ECG during anginal pain episodes. monitor the client every hour Assess signs of hypoxemia, give oxygen therapy if necessary. Give analgesics as directed. Maintain a rest for 24-30 hours during episodes of illness Check vital signs, during periods of illness. Yes Yes 100 beats per minute o.18 s 0.04 s 0.32 s ST depression

Nursing Action/ Remarks

ECG Interpretation Exercise Patients Name: Reyes, Caridad Manuel Is there a P wave? Is the rhythm regular? What is the heart rate/ min? What is the P-R interval? What is the QRS duration? What is the QT interval? Describe the ST segment interpretation. What is your interpretation? Yes Yes 75 beats per minute 0.20 s 0.06 s; slurred QRS 0.44 s Isoelectric ST segment Normal Sinus Rhythm, with isolectric ST segment; slurred qrs; caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals travelling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia. If the client should faint he should be laid flat and his/her vital signs should be immediately obtained. Specifically the heart rate should be determined. If a pulse is not present and the client is unconscious, ACLS must be done If the client is experiencing palpitations, feeling a rapid heart rate (in excess of 160 bpm), has chest pain (s/he may state that her/his heart feels funny or hurts or that her/his heart feels like it will explode) then the following actions should be taken: Have the client sit down and try to convert the fast rhythm by blowing on her/his thumb as if it were a trumpet while also holding her/his nose. S/He should repeat this maneuver every five minutes or so. S/He can also place her/his face in ice water trying to convert the rhythm.

Nursing Action/ Remarks

ECG Interpretation Exercise Patients Name: Martirez, Romeo Macalinao Is there a P wave? Is the rhythm regular? What is the heart rate/ min? What is the P-R interval? What is the QRS duration? What is the QT interval? Describe the ST segment interpretation. What is your interpretation? No No 190 beats per minute none 0.06 s none Depressed ST segment Supraventricular tachycardia with depressed ST segment; rapid heart rhythm originating at or above theatrioventricular node. Supraventricular tachycardias can be contrasted with the potentially more dangerous ventricular tachycardiasrapid rhythms that originate within theventricular tissue; Depressed ST segment is often a sign of myocardial ischemia, of which coronary insufficiency is a major cause. Provide oxygen per nasal cannula monitor ECG for rate rhythm and conduction Monitor vital signs administer diazepam as ordered Prepare E-Cart as needed Assess signs of hypoxemia, give oxygen therapy if necessary. Give analgesics as directed. Maintain a rest for 24-30 hours during episodes of illness assist in vagal stimulation administer anti-arrythmics as ordered

Nursing Action/ Remarks

Insights: Learning about how to prepare a client for ecg, performing the ecg itself, and interpreting the results is an important aspect in the learning of a nurse, for a better quality of care and to promote the welfare of the client. The ecg is an important tool used for the diagnosis and treatment of various cardiac and other related diseases. The recorded tracing of the ecg waveforms produced by the heart can tell you basic information about a patients condition. The ability to evaluate various ecgwaveforms is an important skill for many health care professionals, especially nurses who are the primary caregiver of clients and are the ones constantly monitoring the clients . In addition, as a nurse knowledgeable about ecg, you may be required to determine if an ecg is normal or abnormal and be able to respond to a cardiac emergency, if necessary. As stated in the previous statements, the nurses role in being skilled and knowledgeable about ecg is important. For me, having a duty in the ecg clinic and being able to attach the different leads to the client, and being able to observe is an important aspect in my learning as a student nurse and in my future career as a medical professional.

Highlights: Training of ecg for nurses provides everything the nurse needs to know about the electrocardiogram. It enables nurses to become skilled practitioners in an area often seen as highly complex. Using real ecg traces as examples, possible effects on the patient and treatment options are needed to be known by the nurse, with a focus on the role of the nurse. The 12 lead electrocardiogram or ecg is a valuable diagnostic tool for assisting in the diagnosis of cardiac disorders or acute injury events. Knowledge of lead configuration, proper skin preparation and placement are components to obtaining an accurate picture of cardiac activity. These skills were learned in the ecg clinic. An important concept to remember is that the electrical activity of the heart precedes the mechanical function of the cardiac cycle. And, each wave is associated with a particular function of the cardiac cycle. Changes in the specific waves can indicate abnormalities in heart chamber size, electrolyte values, acute myocardial infarction or STEMI patterns and electrical conduction defects as a result of ischemia, clot or hypertrophic changes related to congestive failure.

Prepared by: Kerima Danica Lising Gayo