EKG certification chapter 6

For my EKG certification I'm very tired

Should the EKG technician identify, prepare, and introduce themselves to the patient before starting the EKG?

Yes duh💀💀💀

Should patients bring their family as interpreters?

No, if the patient and technician do not speak the same language, a professional interpreter will be provided

Identification

First step when preparing a patient for an EKG test, ensures that it is the right person. If not properly identified it could lead to a duplicate medical record

What are the two necessary identifiers to ensure proper patient identification?

Full name and date of birth

Should the patients room number or address be used as an identifier?

No these may change

What should the technician do if the patients information doesn’t match what is on the patients wristband?

Technician should report the problem, tests should be performed until full patient identity is confirmed.

Why should EKG technicians observe the patients skin before placing electrodes?

They need to check for moisture, dryness, oil, dirt, sweat and body hair because this may affect electrode contact but can easily be cleaned off to proceed. Open scars and implanted pacemakers can also prevent proper contract and these two special cases should be avoided.

How can the technician reassure the patient before testing

They can reassure the patient that the test is harmless and the it’ll give their provider a beater idea of their heart rate and rhythm.

Why is it important to reassure pediatric patients?

Children may be scared of doctors and medical procedures, it’s important that children are assured that the test is completely harmless and only takes a few minutes. (Electrodes can be called stickers)

Can patients with developmental disabilities be accommodated by a chaperon?

Yes they can have a caregiver or parent with them during the procedure.

What should you do when patient has hair on the areas electrodes need to be placed?

Clip the hairs

What should you do right AFTER the tracing has been completed?

Check the EKG for evidence of lethal dysrhythmias or ST segment abnormalities as well as artifact.

Can the same electrodes be reused on the same patient twice?

No because the electrode can conduct less effectively once the gel has already conducted electrical activity.

Telemetry Pack

AKA telemetry unit, is used to monitor patients heart rate and rhythm in an inpatient facility, they immediately notify the healthcare provider for even small changes and abnormalities. Typically kept in the patients pocket on their person. Patient must notify EKG technician or nurse if the electrode falls off or is loose.

Stress Test

Measures how the heart functions under controlled stress, normally done on a treadmill or stationary bike.

Pharmacologic Stress Test

Stress test created with medication or injected stimulant medications, most common for patients who cannot exercise.

Nuclear Stress Test

Another type of stress test, a harmless radioactive substance called a tracer is injected into the patients bloodstream. A special camera tracks the motion of the tracer in the patients heart. (Gives provider more information about possible coronary artery blockages)

What position are patients put in before a nuclear stress test?

Supine position with arms over their head

What should the patient avoid before the stress tests?

Avoid caffeine, or certain medications for 24 hours before the exam, and follow the providers instructions for any regular medications 24 hours before the test. (Some medications will have to be stopped temporarily)

Should the patient eat right before a stress test?

No, a patient should not eat or drink anything except water 3 hours before the test.

Should the patient be advised to wear comfortable clothing before the stress test?

Yes

How long can a typical stress test EKG procedure take?

Up to 3 to 4 hours

What EKG lead placement is done on the patient during the stress test?

A 12-lead EKG during the procedure(limb leads are placed on torso for better movement) The EKG is also repeated 5-15 minutes later after the exercise. Vital signs are also monitored every 2.5 seconds during the test.

What is the heart rate goal for the patient during the stress test?

85% of the rate called “age-predicted maximal heart rate”

Age-Predicted Maximal Heart Rate

Calculated by subtracting the patients age from 220:

• Step 1: 220-patient’s age= age-predicted maximal heart rate

• (The heart rate the patient should achieve during the test is 85% of the number received in step 1)

• Step 2: Age-predicted maximal heart rate x 0.85 = target heart rate(goal) for test

Crash Cart

Cart with supplies needed for medical emergency

Should stress test only be done by technicians also trained in CPR?

Yes, and there should also be an AED, oxygen, and crash cart available for emergency during testing.

What are reasons that the stress test should be stopped?

• Dizziness

• Chest pain

• Shortness of breath

• Sudden increase in systolic or diastolic BP

• Systolic BP> 250mm Hg

• Diastolic BP> 115 mm Hg

• Leg cramping/ tingling in lower extremities

• Severe fatigue

• ST segment changes

• Worsening or lethal dysrhythmias

• If patient wants to stop

• Heart rate does not pass 120 BPM

Holter Monitors

Allow physician to evaluate cardiac activity on a longer period of time over 24-48 hours.

Can the patients skin me gently washed or abraded for better electrode adherence?

Yes, a gauze or some soap and water can be used for this.

What should the technician do right before attaching the Holter monitor to the patient?

Check if the monitor has fresh batteries, if it doesn’t, replace them.

Stress Loop

Allows or the patient wearing the ambulatory monitor (In most cases Holter monitor) to continue daily activities. This loop with the wires allows for their to be reduced tension and tugging on electrodes by patients movement. When created, place tape over it.

Should the patient keep a symptom diary?

Yes, but if the symptoms are concerning, press the event button

Can the patient get the monitor wet or swim?

NO

Should the patient call the office if the electrodes loosen or fall off?

Yes

What should a Holter monitor patient do if they are experiencing chest pain, weakness, or shortness of breath?

Call 911 immediately

EHR

Electronic Health Record