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Nur 463 Exam 1 Review Notes
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This is a comprehensive and detailed review note on exam 1 for Nur 463. *Essential Study Material!!
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Exam 1 notes Advanced medical surgicalNursing management of patients with complex cardiovascular disorders
1. What is an EKG
a. EKG or ECG stands for Electro-cardio-gram
i. This tool produces a wave form picture of the hearts Electrical impulse
conduction
1. Electrical activity normally produces mechanical activity
2. 12 leads look at the heart activity from 12 different angles
b. leads of a 12 lead
i. 3 standard limb leads
ii. 3 augmented limb leads
iii. 6 precordial leads
c. impulses towards electrode
i. positive QRS complex
1. this means that if the lead is to the right or bottom of the heart it
will pick up a positive looking peak in a normal heart
d. impulses away from electrodes
i. negative QRS complex
e. standard limb leads are I, II, III
i. the electordes are RA, LA, and LL
1. the leads are the imaginary lines that run between them
2. it looks like a triangle
ii. these leads are bipolar
1. meaning that the lead has both a positive and negative electrode
ex RA and LL equals lead II
iii. electricity flows from negative to positive
f. lead I
i. right arm to left arm
g. lead II
i. right arm to left leg,- this produces the classic ecg reading
h. lead III records flow from left arm to left leg
i. precordial leads
i. chest leads, unipolar and placed over the heart
1. unipolar means that the lead is just a positive electrode and does
not pair like the standard leads do
ii. V1 4th inter costal right sternal border
iii. V2 4th intercostal left sternal
iv. V3 half way between V2 and V4
v. V4 5th intercostal space min clavicular,- maximal impulse of the heart is
here
vi. V5 5th intercostal anterior axillary line
vii. V6 5th intercostal left midaxillary line
2. Cardiac monitoring
a. Most ICU’s use five- lead system
, i. Limb leads
ii. One precordial lead that is moved to get different views
b. Telemetry units and ER often use three lead systems
i. Also know as standard leads
c. For documentation and evaluation
i. Record 6 second strip every 4 hours
ii. Monitor st segment
iii. Monitor dysrhythmias
iv. Daily 12 lead ECG for cardiac patients
d. Common question is about ST segment
i. STEMI means death of the # layers
ii. Non STEMI is normally just the endocardial surface
3. How to analyze cardiac rhythms
a. Paper graph
i. 1 box has 25 little boxes
1. each little box is 0.04 seconds
2. large box is 0.20 seconds
3. 5 boxes 1 second and so on
ii. vertical boxes
1. 1 small box 0.1 mV
2. small wave = low voltage
3. large wave = high voltage
iii. P- wave
1. Atrial chamber Sa node
a. Is the action potential
that makes the atrium
contract
2. PR interval 0.12-0.2
a. SA to the AV
i. Impulse is
slowed to allow
for Artial kick
b. QRS-
i. ventricles depolarize
c. ST segment
i. Ventrical repolarize
1. The heart is sensitive – could fire before it is
ready and then you would get an R on T
which can lead to Vtach
d. U wave is a sign of hypokalemia
i. It is after the t wave and before the P wave
3. Side note PEA is Pulseless electrical activity- meaning everything
looks good on the ekg but the heart isn’t pushing out blood
b. Cardiac conduction path ways
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