CH IV, V, VI: ecg, ngt, ifc

What is the definition of a 12-lead Electrocardiogram (ECG)?

A non-invasive diagnostic test that records the heart's electrical activity using surface electrodes to translate depolarization and repolarization vectors into 12 graphical tracings.

What are the goals of Rhythm Analysis in an ECG?

To identify rate, baseline rhythm, and cardiac dysrhythmias such as atrial fibrillation, ventricular tachycardia, or heart blocks.

In ECG interpretation, what does ST-segment elevation (STEMI) indicate?

Myocardial infarction and ischemia corresponding to specific coronary artery territories.

How can an ECG be used as a monitoring tool for electrolytes?

It can detect imbalances such as hyperkalemia, which presents with peaked T waves.

What are the three Bipolar (Standard) ECG limb leads?

Lead I, Lead II, and Lead III.

Which electrode poles define Lead I?

Right Arm (-) to Left Arm (+).

Which electrode poles define Lead II?

Right Arm (-) to Left Leg (+).

Which electrode poles define Lead III?

Left Arm (-) to Left Leg (+).

What does 'aVR' stand for in an ECG?

Augmented Vector Right.

What does 'aVL' stand for in an ECG?

Augmented Vector Left.

What does 'aVF' stand for in an ECG?

Augmented Vector Foot.

Which heart structures do precordial leads V1 and V2 view?

The Right Ventricle and Interventricular Septum.

Which heart structure do precordial leads V3 and V4 view?

The Anterior wall of the Left Ventricle.

Which heart structure do precordial leads V5 and V6 view?

The Lateral wall of the Left Ventricle.

How many electrodes are required to obtain a 12-lead ECG?

$10$ electrodes.

What skin preparation is needed before placing ECG electrodes?

Clean the skin with alcohol pads to remove sebum, sweat, and dead cells, and allow it to air dry.

What is the standard patient position for an ECG?

Supine position.

If a patient is orthopneic during an ECG, what position should be used?

Semi-Fowler’s position.

Why must a patient be kept warm during an ECG?

To prevent shivering, which creates muscle tremor artifacts.

What color is the Right Arm (RA) electrode according to AHA standards?

White.

Where is the Left Arm (LA) electrode placed?

Inner wrist or upper arm, avoiding bony prominences.

What is the color and purpose of the Right Leg (RL) electrode?

Green; it acts as the Ground Lead.

Where is electrode V1 placed?

$4^{th}$ Intercostal Space (ICS) at the Right Sternal Border.

Where is electrode V2 placed?

$4^{th}$ Intercostal Space (ICS) at the Left Sternal Border.

Where is electrode V3 placed?

Directly midway between V2 and V4.

Where is electrode V4 placed?

$5^{th}$ Intercostal Space (ICS) at the Left Midclavicular Line.

Where is electrode V5 placed?

$5^{th}$ Intercostal Space (ICS) at the Left Anterior Axillary Line, on the same horizontal plane as V4.

Where is electrode V6 placed?

$5^{th}$ Intercostal Space (ICS) at the Left Midaxillary Line, on the same horizontal plane as V4.

How do you locate the fourth intercostal space using the 'Angle of Louis'?

Feel for the sternal angle ridge where the $2^{nd}$ rib attaches, then move down two intercostal spaces.

What is the standard ECG paper speed calibration?

$25\,mm/sec$.

What is the standard ECG voltage/gain calibration?

$10\,mm/mV$.

What causes a 'Somatic Tremor' artifact on an ECG?

Muscle movement, shivering, anxiety, or Parkinson's disease.

What is a fix for a 'Wandering Baseline' artifact?

Re-prep the skin, re-apply gel pads, and secure wires.

What causes 60-Cycle Interference (AC Artifact)?

Electrical equipment in the room.

How should precordial leads be placed for a patient with Dextrocardia?

Reverse the precordial leads to the right side of the chest ($V1R-V6R$).

Where is V4R commonly placed in children under 2 years old?

On the right side of the chest to assess right ventricular status.

What is a Nasogastric Tube (NGT) insertion?

An invasive procedure where a flexible tube is passed through the naris, nasopharynx, and esophagus into the stomach.

What is the purpose of NGT decompression?

To remove gas, secretions, and stomach contents to relieve abdominal distention or obstruction.

What is Gavage in the context of NGT usage?

Administration of enteral nutrition, fluids, and medications when oral intake is unsafe.

What is Gastric Lavage?

Washing out stomach contents in cases of toxic ingestion or GI bleeding.

What is a Salem Sump Tube?

A double-lumen tube used for suction with a blue vent lumen to equalize vacuum pressure.

What is the purpose of the blue vent lumen on a Salem Sump tube?

It prevents the tube tip from adhering to or damaging the gastric mucosa.

What is a Levin Tube?

A single-lumen tube used for feeding or intermittent low suction.

What are the characteristics of a Dobhoff tube?

A flexible, narrow-bore tube with a weighted tip and wire stylet used exclusively for enteral nutrition.

What is the standard adult size for an NGT?

$14-16\,Fr$.

Why is petroleum jelly avoided as a lubricant for NGT insertion?

Risk of lipid pneumonia.

What patient position is required for NGT insertion?

High-Fowler’s position ($90^{\circ}$).

How do you assess nostril patency before NGT insertion?

Occlude one nostril at a time and ask the patient to breathe; select the side with superior airflow.

What is the NEX Rule for measuring NGT length?

Measure from the Tip of the Nose, to the bottom of the Earlobe, down to the Xiphoid process.

How many inches are added to the NEX measurement for dual gastric placement?

$2$ to $4$ inches.

What should the patient do when the NGT reaches the nasopharynx?

Flex their chin down toward their chest to close the trachea and open the esophagus.

What technique helps the NGT advance through the esophagus?

Having the patient take small sips of water and swallow continuously.

What is the primary gold standard for NGT placement verification?

Abdominal/Chest X-Ray confirmation.

What is the expected pH range for fasting gastric contents?

pH $1$ to $5$. (acidic)

What is the expected pH range for NGT aspirate if it reached the respiratory tract?

pH $> 7$.

What is the typical visual appearance of gastric fluid?

Grassy green, off-white, or tan/clear with mucus.

Why is auscultation of an 'air whoosh' no longer a recommended NGT verification method?

It is not reliable according to evidence-based guidelines.

How is a Salem Sump blue vent maintained?

It must be kept above the level of the stomach and never clamped.

What should a nurse do if a patient exhibits respiratory distress during NGT insertion?

Immediately withdraw the tube as it likely entered the trachea.

What is the preferred suction setting for a Salem Sump tube?

Low Intermittent Suction ($30-40\,mmHg$).

How often should mouth care be performed for a patient with an NGT?

Every $2-4$ hours.

When administering enteral medications via NGT, how long should suction remain off?

$30-60$ minutes.

What is the required flush volume before and after NGT medication administration?

$15-30\,mL$ of water.

What is an Indwelling Foley Catheter (IFC)?

A sterile dual/triple-lumen tube inserted through the urinary meatus into the bladder and held by an inflatable balloon.

What is an indication for IFC insertion?

Relief of acute urinary retention or bladder outlet obstruction (e.g., BPH).

When is an IFC indicated for pressure injury management?

Stage III/IV pressure injuries on the sacrum/coccyx to facilitate healing from incontinence.

What are the two lumens in a standard 2-Way Foley catheter?

Lumen 1 for urine drainage and Lumen 2 for balloon inflation.

What is the purpose of the third lumen in a 3-Way Foley?

Continuous inflow of sterile irrigation solution to flush blood clots (CBI).

What is the standard French size range for female catheters?

$14\,Fr - 16\,Fr$.

What is the standard French size range for male catheters?

$16\,Fr - 18\,Fr$.

What size is a standard adult Foley balloon and how much water is needed to fill it?

Standard size is $10\,mL$; requires filling with approximately $10\,mL$ of sterile water.

What is the correct position for a female patient during catheterization?

Dorsal Recumbent Position.

What is the alternative position for a female patient with hip contractures during IFC insertion?

Side-lying (Sims) position.

What is the correct position for a male patient during IFC insertion?

Supine position with legs fully extended and slightly abducted.

In what order is a sterile catheter kit opened?

Open the outer flap away from you first.

How far should the catheter tip be lubricated for a female patient?

$1$ to $2$ inches ($2.5$ to $5\,cm$).

How far should the catheter tip be lubricated for a male patient?

$5$ to $7$ inches ($12.5$ to $17.5\,cm$).

Which hand becomes unsterile during the IFC cleansing process?

The non-dominant hand once it touches the patient's anatomy.

What is the cleansing protocol for a female patient before IFC insertion?

Wipe with saturated cotton: labia majora far side, labia majora near side, then directly over the meatus (all top to bottom).

How is the male meatus cleansed for catheterization?

In a circular motion starting at the meatus and working outward toward the glans.

How far is a female catheter inserted before inflating the balloon?

Insert $2$ to $3$ inches ($5$ to $7.5\,cm$) until urine flows, then advance an additional $1$ to $2$ inches.

How far is a male catheter inserted before inflating the balloon?

Insert $7$ to $9$ inches ($17.5$ to $22.5\,cm$) up to the catheter 'Y' bifurcation junction.

What should you do if a patient reports acute pain during Foley balloon inflation?

Stop immediately, deflate the balloon, advance the catheter further, and re-try.

What is the purpose of pulling back gently on the catheter after balloon inflation?

To seat the balloon against the bladder neck.

What must be done for an uncircumcised male after catheter insertion?

Reposition the foreskin forward over the glans to prevent paraphimosis.

Where is the StatLock securement device placed on a female?

Upper inner thigh.

Where is the StatLock securement device placed on a male?

Top of the thigh or lower abdomen.

Where should a urinary drainage bag be attached?

To the bed frame below the level of the bladder (never to moveable rails).

What does 'CAUTI' stand for?

Catheter-Associated Urinary Tract Infection.

How is the closed drainage system maintained in CAUTI prevention?

Do not disconnect tubing unless flushing under sterile orders.

What is the guideline for emptying a urinary drainage bag?

Empty when it is $1/2$ to $2/3$ full or every $8$ hours.

How should sterile water be removed from a Foley balloon for removal?

Fully evacuate using a syringe via gravity (do not forcefully pull back).

What is the monitoring requirement after Foley catheter removal?

Record the time and volume of the first void; the patient must void within $6-8$ hours.

What is '60-Cycle Interference' fix?

Unplug non-essential electronic devices and ensure the machine is grounded.

What are the three verification methods for NGT placement at the bedside?

pH testing of aspirate, visual assessment of aspirate, and (though not primary) auscultation.

What is the purpose of a fenestrated drape in an IFC kit?

To provide a sterile opening over the perineum for the procedure.

How is the 'Gold Standard' verification defined for IFC?

Direct visualization of urine return.

What is the measurement rule for NGT in the recap table?

Nose to Earlobe to Xiphoid (NEX).

What is the measurement rule for Male IFC insertion depth?

$7-9$ inches (to the bifurcation).

What is the asepsis level for NGT insertion?

Clean Technique.