EKG Test Review (HSTC)

HIPAA

A federal law that protects patient health information (PHI). It ensures that only authorized individuals can access or share patient information

If patients request to see any medical records, this information must be provided within ___ of the request

30 days

What type of consent is needed for EKG?

Implied

What possible situations could warrant a chaperone?

Patient is a minor, impaired, sedated, or the provider is the opposite gender

What type of transmission precaution is recommended by both OSHA and CDC when performing an EKG?

Medical Asepsis

Medical Asepsis

(A clean technique) a practice designed to reduce the number and transfer of pathogens, as well as break the chain of infection

chain of infection

Infectious Agent - Reservoir - Portal of Exit - Mode of Transmission - Portal of Entry - susceptible host

Handwashing

Use soap and water for at least 20 seconds or hand sanitizer w/ at least 60% alcohol when soap and water aren’t available

before patient contact

wash your hands

before performing clean or aseptic procedures

wash your hands

after exposure to bodily fluids or touching the patient

wash your hands

After touching patient surroundings

wash your hands

After handling contaminated items

wash your hands

to minimize the risk of spreading infection, when should the EKG machine, cables, and exam table be disinfected?

Between Patients

Therapeutic communication

a form of communication where the EKG technician creates an environment that promotes trust, empathy, and the well-being of the patient. Focuses on understanding the patient’s feelings, thoughts, and concerns in a compassionate manner.

Therapeutic communication methods

active listening, empathy, clear language, open-ended questions

Tips for working with people w/ a language barrier

use simple language, use an interpreter or translation services, show empathy and patience

Tips for working with people with vision loss

speak clearly and describe actions, offer assistance if needed, use touch for guidance

tips for working with people w/ hearing loss

face the patient and speak slowly, use written communication, use an interpreter

How should an EKG patient introduce themselves to a patient?

establish clear and accurate identification by asking for the patient’s full name, date of birth, home address, telephone number, or photo ID card. State your name, purpose, and then get their info in a calm and approachable way

Acceptable identifiers

Patient’s full name, date of birth, home address, telephone number, photo ID cardWhat d

What does blood pressure measure?

The pressure of blood against artery walls

Describe Korotkoff sounds

They are the vascular sounds (tapping, whooshing, thumping, or muffling) heard through a stethoscope over brachial artery during manual bp measurement

Systole

the connection phase where blood is ejected into circulation, causing high pressure

diastole

the relaxation phase when the heart fills w/ blood allowing pressure to drop

Both Systole and Diastole -

Two main phrases of the cardiac cycle, represents the hearts pumping and filling cycle

normal systolic mm Hg

90 - 120

elevated (prehypertension) systolic mm Hg

120-129

stage 1 hypertension systolic mm Hg

130-139

stage 2 hypertension systolic mm Hg

greater than or equal to 140

hypertensive systolic mm Hg

greater than or equal to 180

normal diastolic mm Hg

less than 80

elevated (prehypertension) diastolic mm Hg

greater than or equal to 80

stage 1 hypertension diastolic mm Hg

80-89

stage 2 hypertension diastolic mm Hg

greater than or equal to 90

hypertensive crisis diastolic mm Hg

greater than or equal to 120

Pulse rate

the number of times your heart beats per mintue

how is pulse rate measured

by the feeling the pulse using the index and middle fingers on the wrist or neck for 30-60 seconds, or via digital monitors

Temporal Description/Location

on the temple, directly in front of the ear and just above the zygomatic arch (cheekbone).

Carotid Description/Location

a strong arterial pulse located on either side of the neck

Brachial Description/Location

On the medial (inner) part of the upper arm, specifically in the elbow crease or just slightly above it

Radial Description/Location

on the wrist, just below the base of the thumb

Femoral

located in the groin crease, roughly halfway between the pubic bone and the hip bone

Popliteal

located in the popliteal fossa, a soft, diamond - shaped depression directly behind the knee

Posterior Tibial

on the inner ankle just behind the medial malleolus (the prominent bump) and in front of the Achilles tendon

Dorsalis Pedis (Pedal)

On the top of the foot, lateral to the extensor hallucis longus tendon

Infant (1-12 months) pulse

100-160 bpm

toddler (1-2) years pulse

90-150 bpm

Preschooler (3 - 5) years pulse

80-140 bpm

school - age child (6 - 15) pulse

70 - 100 bpm

adolescent and older pulse

60 - 100 bpm

what is a respiration

the number of breaths a person takes per minute

how is a respiration measured

typically measured at rest

infant (1-12) months respiratory rate

30 - 60 breaths per minute

toddler (1-2 years) respiratory rate

24-40 bpm

preschooler (3-5 years) respiratory rate

22-34 breaths pm

school - age child (6 to 15 years) respiratory rate

18-30 breaths pm

Adolescent and older respiratory rate

12-20 breaths pm

what does blood pulse oximetry measure?

the percentage of oxygen - saturated hemoglobin in your blood and your pulse rate

what is a normal pulse oximetry reading (SpO2)?

95% - 100%

What is the average normal body temperature in both Fahrenheit and Celsius?

98.6 F (37 C)

What temperature is considered a fever in both Fahrenheit and Celsius

100.4 F (38 C) or higher

Patient identification

full name, DOB, address, picture ID, social security number, compare this info w/ patients wristband or chart, never use room or bed number

medication reconciliation

ask abt. current medications, including: prescribed medications, over the counter (OTC) drugs, herbal suppliments

Medical history

Ask abt. past and current medical conditions (Ex: hypertension, previous heart attack, heart arrythmias, heart failure, peacemaker/implants)

Family History

collect info abt. the health and history of the patients immediate family,

Social History

gather info about lifestyle, habits and social environment (smoking, drinking, exercise)

Preparation for EKG

Ensure the patient is comfortable, explain the process, and check for skin oils or excess hair. Make sure you have 2 identifiers

Positioning for an EKG

Supine position and keep them still

Draping for EKG

drape their chest and limbs minimally and exposing only the areas for electrodes placement to get electrical signals.

Position for patient with parkinson’s

Patient lies in supine position

Should you use a razor or clippers to remove chest hair?

Electric clippers because it prevents infections and is softer for patients with parkinsons disease.

List the supplies needed to perform an EKG

EKG machine w/ cable, wires, 10 composable electrodes, electrode gel, alcohol wipes, skin prep pads, abrasive rope, thermal recording paper

What position is required for an EKG

supine

Patients experiencing dyspnea when lying flat, have COPD or other pulmonary disorders can be placed in what position

upright or supported

what position might be used for pregnant patients in their third trimester

left lateral tilt

what patient data should be entered into the machine

name, dob, unique patient identifier, gender, age

after preparing the patient, applying electrodes, and attaching leads, it will be time to conduct the test

the tech will tell the patient to not move, breathe normally, try to relax, avoid moving your arms and legs, and not hold in their breath

Describe the pre-procedure instructions that should be given to a patient

Avoid eating or drinking for 3-4 hours before. No caffeine or tobacco before, tell them to consult a physician regarding medication. Also, tell them to wear comfortable clothing.

1st step of a stress test

get hooked to heart monitor

2nd step of a stress test

start walking on a treadmill or pedaling a bike

3rd step of a stress test

the speed/difficulty increases

4th step of a stress test

watch patient heartrate, breathing, and blood pressure

what is bruce protocol

a standard way to do a treadmill stress test, gets harder over time

what is the name of the dye that provides additional information on blood flow within the heart

contrast dye

what is done for patients who cannot run on a treadmill or ride a stationary bike

pharmocological stress test, medicine like adenosine, or dobutamine

when should a stress test be stopped immediately

chest pain, trouble breathing, dizziness or feeling like passing out

RA

right arm, below the left calvicle

LA

left arm below the left clavicle

RL

right leg left lower cage to the abdomen

VI

4th intercostal space at the right margin of the sternum

V2

4th intercostal space at the left margin of the sternum

V3

midway between V2 and V4

what does ST depression represent on an ECG?

not enough blood/oxygen to heart muscle

What does ST elevation represent on an ECG

serious heart muscle injury

Naughton protocol

Slower, gentler treadmill stress test w/ gradual increases

Bruce Protocol

faster, harder test that increases quickly every 3 minutes. Incline increases w/ intensity

How do you calculate max heart rate for a stress test

max heart rate 220-age

when performing a stress test, the procedure can be stopped when the patient reaches what percentage of their target heart rate

85%

A 3-lead EKG is generally used for

continuous monitoring