Transcript The Profession of Medical Assisting - McGraw

CHAPTER
49
Electrocardiography
and Pulmonary
Function Testing
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49-2
Learning Outcomes
49.1 Discuss the medical assistant's role in
electrocardiography and pulmonary function
testing.
49.2 Explain the basic principles of
electrocardiography and how it relates to the
conduction system of the heart.
49.3 Identify the components of an
electrocardiograph and what each does.
49.4 Carry out the steps necessary to obtain an
ECG.
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49-3
Learning Outcomes
49.5 Summarize exercise electrocardiography
and echocardiography.
49.6 Explain the procedure of Holter monitoring.
49.7 Carry out the various types of pulmonary
function tests.
49.8 Describe the procedure for performing pulse
oximetry testing.
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49-4
Introduction
• Cardiac testing
– Electrocardiogram
– Holter monitoring
– Stress testing
• Respiratory testing – pulmonary function
testing
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49-5
The Medical Assistant’s Role in Electrocardiography
and Pulmonary Function Testing
• Medical assistant may perform
– Electrocardiography
– Pulmonary function tests (PFTs)
– Diagnostic reasons
– Part of general exam
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49-6
Basic Principles of Electrocardiography
• Heartbeats produce electrical current
• Resting cardiac cell – polarized
• Depolarization
– Occurs when cell loses polarity
– Electrical impulse initiates contraction
– Impulse detected by electrodes
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49-7
Basic Principles of Electrocardiography
• Depolarization
• Repolarization –
electrical
recovery
• Cardiac cycle –
sequence of
contraction and
relaxation
• Polarized
state
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49-8
The Basic Pattern of the
Electrocardiogram
• Electrocardiogram (ECG) produces the
electrocardiograph
– Tracing of waves and lines produced by the
cardiac cycle
– Deflections
• Peaks and valleys
• Sections labeled PQRSTU
To example
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49-9
Apply Your Knowledge
1. What two procedures might the medical
assistant preform?
ANSWER: Electrocardiography and pulmonary
function testing.
2. What is the term for the depolarization,
repolarization, and polarized state sequence?
ANSWER: The cardiac cycle.
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49-10
The Electrocardiograph
• Impulse is detected by electrodes
• Transmitted by insulated wires
• Amplified by the electrocardiograph
machine
• Stylus – records the movement
• Leads – views of electrical activity
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49-11
Types of Electrocardiographs
• Standard – 12-lead electrograph
• Single-channel
• Multichannel
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49-12
Electrodes and Electrolyte Products
• Electrolyte is needed to enhance
transmission of electric current
• Electrodes are placed
– One on each arm
– One on each leg
– Six on chest
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49-13
Leads
• Limb leads
– Three standard leads
• Bipolar
• Designation – I, II, III
– Three augmented views
• Unipolar
• Amplified
• Designation – AVF, AVR, AVL
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49-14
Leads
• Precordial leads
– Unipolar
– Designated V1
through V6
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49-15
ECG Paper
• Standardized pattern of small and large
squares
• Horizontal axis – time in seconds
• Vertical axis – voltage (mV)
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49-16
The Electrocardiograph Controls
• Standardization control
• Speed selector
• Sensitivity control
• Lead selector
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49-17
The Electrocardiograph Controls
• Centering control
• Line control
• On/Off switch
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49-18
Apply Your Knowledge
Matching:
ANSWER:
G Adjusts position of stylus
___
A. Vertical axis
B Adjusts height of tracing
___
B. Sensitivity control
H Adjusts darkness of tracing
___
C. Precordial leads
A Measures strength of impulse
___
D. Horizontal axis
D Measures time
___
E. Limb leads
E AVF, AVR, AVL
___
F. Amplification
C V1 through V6
___
G. Centering control
F Increases signal
___
H. Line control
Superbly
Matched!
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49-19
Performing an ECG
• Proper technique essential
• Preparing the room and equipment
– Turn off other electrical equipment
– Quiet room, comfortable temperature
– Check machine
• Warm up
• Adequate paper
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49-20
Performing an ECG (cont.)
• Preparing the patient
– Introduce yourself
– Explain the procedure
– Answer questions
– Ensure patient comfort
– Perform ECG procedure
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49-21
Applying the Electrodes and the
Connecting Wires
• Electrodes
• Positioning electrodes
– Use consistent technique
– Limb electrodes ~ place at
same level
– Precordial electrodes ~
specific intercostal spaces
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49-22
Applying the Electrodes and the
Connecting Wires (cont.)
• Attaching wires
– Numbers and letters correspond to electrodes
– Connect limb wires first
– Precordial in same sequence as electrodes
– Avoid tension
on wires
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49-23
Operating the Electrocardiograph
• Standardize
• Run the ECG
• Check the tracing
– Clear
– Free from artifact
– Automatic
– Manual
– Multiple-channel
Source: Courtesy of Cardiac Science Corporation, Milton, Wisconsin
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49-24
Troubleshooting: Artifacts and Other
Problems
• Artifacts
• Wandering
baseline
– Improper technique
– Poor conduction
– Outside
interference
– Improper handling
Source: Courtesy of Cardiac Science Corporation, Milton, Wisconsin.
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49-25
Troubleshooting: Artifacts and Other
Problems (cont.)
• Flat line – loose or
disconnected wire
• Extraneous marks
– careless handling
Source: Courtesy of Cardiac Science Corporation, Milton, Wisconsin.
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49-26
Troubleshooting: Artifacts and Other
Problems (cont.)
• Causes
– AC interference
– Somatic interference
Source: Courtesy of Cardiac Science Corporation, Milton, Wisconsin.
Source: Courtesy of Cardiac Science Corporation, Milton, Wisconsin.
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49-27
Troubleshooting: Artifacts and Other
Problems (cont.)
• Identifying source
– Check tracings for leads I, II, and III
– If unable to identify source, stop and notify
supervisor of problem
– Leave patient connected
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49-28
Completing the Procedure
• Acceptable tracing
– Label tracing properly
– Disconnect wires from electrodes
– Remove electrodes/wipe off electrolyte
– Assist patient as needed
– Prepare room appropriately
• Mount tracing if necessary
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49-29
Completing the Procedure (cont.)
• Interpreting the ECG
– Not a medical assistant responsibility
– Be able recognize a problem requiring
immediate attention
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49-30
Completing the Procedure (cont.)
• Interpreting the ECG – heart rhythm
– Regularity of the heartbeat
– Distances between complexes and waves is
normally consistent
– Rhythm strip – lead II
To example
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49-31
Completing the Procedure (cont.)
• Heart rate – count QRS complexes in a 6second strip and multiply by 10
• Intervals and Segments – look for
variations in length and position
• Wave changes – should be similar
appearance in each lead
To example
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49-33
Completing the Procedure (cont.)
• Cardiac Arrhythmias
– Ventricular fibrillation
– Premature ventricular contractions
– Atrial fibrillation
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49-34
Apply Your Knowledge
1. Electrodes are placed at how many positions on the
body?
ANSWER: Ten: four limb and six chest
positions.
2. What should you do just prior to running the
ECG to see if the machine needs adjusting?
What should you do upon completion of the
test?
ANSWER: Standardize the electrocardiograph prior
to running the tracing. Upon completion of the
ECG, you should check the tracing to be sure is it
clear and free from artifact.
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49-35
Apply Your Knowledge
3. What should you do just prior to running the ECG to see if the machine
needs adjusting? What should you do upon completion of the test?
ANSWER: Standardize the electrocardiograph prior to running the
tracing. Upon completion of the ECG, you should check the tracing
to be sure is it clear and free from artifact.
4.
What are four general causes of artifacts?
ANSWER: They are improper technique, poor conduction, outside
interference, and improper handling of the tracing.
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49-36
Exercise Electrocardiography (Stress
Testing) and Echocardiography
• Exercise electrocardiography
or stress test – measures
response to exercise
• Echocardiography
– Ultrasound
– Resting or post exercise
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49-37
Exercise Electrocardiography
• Uses
• Procedure – monitoring during
exercise
• Medical assistant
– Prepare and monitor patient
– Be sure consent form is signed
– Patient instructions
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49-38
Echocardiography
• Purpose
• Medical assistant
• Types
– Transthoracic
– Be sure consent form
is signed
– Patient instructions
– Transesophageal
– Doppler
– Stress echo
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49-39
Ambulatory Electrocardiography (Holter
Monitoring)
• Monitors heart over a
24-hour period of
normal activity
• Function
• Patient education
– Keep diary
– What to avoid
– How to check monitor
– 24 hour recording
– Tracing irregularities
compared to events in
diary
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49-40
Apply Your Knowledge
What is the purpose for stress testing, echocardiogram,
and Holter monitor testing?
ANSWER: Stress testing is used to measure the
heart’s response to a constant or increasing workload.
An echocardiogram shows the working heart valves
and chambers and how well the blood moves through
the heart.
A Holter monitor is used to obtain a tracing over a
period of time when a resting ECG or stress test
shows no abnormalities.
Correct!
All are used for diagnosing cardiac conditions or for
monitoring current treatments and medications.
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49-41
Pulmonary Function Testing
• Evaluates lung volume and capacity
• Uses
– Evaluate of shortness of breath
– Detect and classify of pulmonary disorders
– Evaluate effectiveness of treatments
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49-42
Spirometry
• Measures breathing
capacity
• Spirometer
– Mouthpiece
– Mechanism to measure volume
– Means of calculating and printing results
• Forced vital capacity
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49-43
Performing Spirometry
•
Patient preparation
– Inform the patient about conditions and
activities that could affect the test accuracy
– Explain procedure and its purpose
– Position the patient properly
– Explain and demonstrate correct procedure
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49-44
Performing Spirometry (cont.)
• Performing the maneuver
– Forcefully coach and provide feedback
– Obtain three acceptable maneuvers
– Observe the patient’s symptoms
– Notify physician if symptoms
occur
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49-45
Performing Spirometry (cont.)
• Medication effectiveness
– Perform test before patient takes medication
– Repeat after patient takes the medication
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49-46
Performing Spirometry (cont.)
• Medication
effectiveness
• Special
considerations
– Perform test before
patient takes medication
– Uncooperative
patients
– Repeat after patient
takes the medication
– Patients who do not
understand
– Patients who cannot
follow directions
– Patients who cannot
perform the procedure
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49-47
Performing Spirometry (cont.)
• Calibration
• Infection control
– Daily ~ keep
logbook
– Calibration
syringe
– Clean after patient
testing
– Dispose of items
appropriately
• Results of testing
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49-48
Peak Expiratory Flow Rate (PEFR)
• Peak flow meter
– Reveal narrowing of airways prior to an
asthma attack
– Physician determines peak flow zones
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49-49
Peak Expiratory Flow Rate (PEFR)
• Peak flow zones
~ good control
~ large airways are beginning to
narrow
~ medical emergency
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49-50
Pulse Oximetry
• Measurement of the oxygen saturation
– Measures amount of light absorbed by
hemoglobin
– Hypoxemia ~ less than 95%
• Uses
– Pulmonary and cardiac
conditions
– Postoperatively
– Sleep apnea
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49-51
Apply Your Knowledge
1. What is the purpose of PFTs?
ANSWER: To evaluate lung volume and capacity.
2. What does successful spirometry testing depend on?
ANSWER: On proper patient preparation and
consistent technique in preforming the procedure and
analyzing the results.
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49-52
Apply Your Knowledge
3. Joey Jackson called to ask about taking his asthma
medicine. He said he has been using his peak flow
meter and the readings have been in his yellow zone.
What do you tell him?
Very good!
ANSWER: This means that his large airways are
beginning to narrow and that he should take his
medication as prescribed.
4. Joey decided to come to the office and you check his
oxygen saturation with the pulse oximeter. The reading
was 93%. What does this mean and what should you do?
ANSWER: Joey is hypoxemic. You need to notify
the physician and document findings.
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49-53
In Summary
49.1 As a medical assistant, you will be
responsible for preparing the patient for ECG
and pulmonary function tests, maintaining
the equipment used for these tests, and
performing them.
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49-54
In Summary (cont.)
49.2
The heart’s conduction system is responsible for the
electrical pathway that occurs during a heartbeat.
The pathway begins with the SA node, travels
through the AV node, Bundle of HIS, Right and Left
bundle branches, and ends with the Purkinje fibers.
This electrical energy pathway is measured with an
electrocardiograph and a tracing of the impulses is
produced. The electrical impulses are represented in
wave forms or deflections. Each deflection is
labeled by letters PQRSTU and represents a part of
the pattern.
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49-55
In Summary (cont.)
49.3
49.4
The electrocardiograph consists of the following
components: electrodes, amplifier, stylus, leads,
and ECG paper.
The steps in obtaining an accurate ECG include
preparing the room and equipment, identifying the
patient, properly placing the limb and chest
electrodes, attaching the lead wires, entering the
patient data into the ECG machine, running the
tracing, checking the tracing for artifacts,
disconnecting the patient from the lead wires and
removing the electrodes, and assisting the patient as
required.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
49-56
In Summary (cont.)
49.5
Exercise electrocardiography is referred to as stress
testing. This measures the efficiency of the heart
during constant or increasing workload.
Echocardiography uses ultrasound to create a
picture of the moving heart. This can be done while
the patient is resting or after exercise.
49.6
A Holter monitor is used to measure the heart’s
activity over a 24-hour period. This is used when the
patient has intermittent chest pain or discomfort and
a normal ECG and stress test.
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49-57
In Summary (cont.)
49.7
Forced vital capacity is the measurement of the
greatest volume of air expelled when a patient
performs a rapid, forced expiration.
Accurate spirometry testing includes proper patient
positioning, coaching the patient during the
procedure, obtaining three acceptable maneuvers,
and recording the results in the patient’s chart.
A peak expiratory flow rate is obtained by having the
patient sit or stand using good posture, take in as
deep a breath as possible, and blow out through the
peak flow meter as fast and as hard as possible
three times.
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49-58
In Summary (cont.)
49.8
Pulse oximetry testing is performed by applying the
pulse oximeter to the patient’s finger or toe, attaching
the sensor cable to the oximeter, turning the oximeter
on, setting the alarm limits for high and low oxygen
saturations, and reading the patient’s oxygen
saturation levels. The oxygen saturation levels should
be recorded in the patient’s chart.
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49-59
End of Chapter 49
As the arteries
grow hard, the
heart grows
soft.
~ H. L. Mencken
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
49-60
Apply Your Knowledge
5260
1. What should you after running an ECG?
ANSWER: After making sure the tracing is
acceptable, you should label it properly, disconnect
wires from electrodes, remove electrodes and wipe
off electrolyte, assist patient up, and prepare the
room appropriately for the next patient.
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution
in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.