8.2: Positioning for Testing

Supine position

Patient lies on their back

Why is supine the most commonly used position?

Offers the best opportunity for electrode adhesion and the least movement by the patient

Supine diagram

Semi-Fowler’s position

Semi-Fowler’s diagram

Prone position

Patient lies face down

Lithotomy position

Patient lies on their back with their legs separated

Lithotomy diagram

Knee-chest position

Patient lies on their side with both their knees bent

Knee-chest diagram

Trendelenburg position

Patient lies on their back, but their head is lower than their feet

Trendelenburg diagram

Jackknife/proctologic position

Similar to the knee-chest position, but the hips are bent further

Jackknife/proctologic diagram

Sims position

Patient lies on their left side with their left hip and lower leg straight, while their right hip and right knee are bent

Sims diagram

For limb amputees

• Place the limb electrode on the residual (hip or shoulder) area

• Place the other limb electrode on the opposite limb

• Make sure both limb electrodes are symmetrical

For patients with a pacemaker or dialysis

Notify the physician that the leads were not in the usual positions

For patients with cognitive disabilities

Gently inform them that no electricity is going into the body, but the machine just records the sounds inside the body

For patients complaining of dyspnea or syncope

Stop the test and notify the physician immediately

When modified patient positioning is used

Document throughly in the patient’s record

Electrode placement on elderly adults

Gently hold the skin while carefully removing each electrode

Body piercings

• May need to be removed if on proper electrode placement due to interference with conduction

• Adjusted electrode placement must be documented in patient’s record

Avoid placing electrodes on scars or tattoos

• Higher skin impedance on these areas

• Make sure to document in the patient’s record if any electrodes are placed on these areas

Uses for a stress test

• Determine the likelihood of coronary artery disease (CAD)

• A blockage of the arteries that supply the heart muscle

• Evaluate patients with a high risk of developing heart disease

Increased oxygen intake during a stress test

The faster heart rate makes it easier to detect decreased blood flow and any vital sign changes

Step 1 of using a Holter monitor

Ensure proper skin preparation for strong adhesion of all 5 electrodes

Step 2 of using a Holter monitor

Carry out all routine daily activities, except for showering or bathing, and document cardiac symptoms with diary or event button

Step 3 of using a Holter monitor

Avoid areas of high-voltage that may interfere with the recording

Wear ___________ ________ _______ and _____-_______ _________ on the day of a cardiac test

Comfortable exercise shoes and loose-fitting clothes

Avoid ________ __ ____ _____ _________ to minimize artifacts on the EKG

Wearing a bra that contains metal

Eat at least __ ______ ______ __ ___ _____

4 hours prior to the test

____ ____________ __ _________ unless otherwise instructed by the physician

Take medication as normal

Why would you instruct the patient to hyperventilate while obtaining baseline vitals before a cardiac test?

Rapid breathing can produce some changes to the recording, if the EKG is taken while the patient is standing