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This chapter introduces you to the electrocardiograph instrument and how to administer an electrocardiogram. You will also learn how to apply electrocardiograph electrodes and wires, operate the instrument, and troubleshoot problems that can occur while recording the hearts electrical activity.
CHAPTER 49 Electrocardiography and Pulmonary Function Testing © 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 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 © 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 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 © 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 49-4 Introduction • Cardiac testing – Electrocardiogram – Holter monitoring – Stress testing • Respiratory testing – pulmonary function testing © 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 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 © 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 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 © 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 49-7 Basic Principles of Electrocardiography • Depolarization • Repolarization – electrical recovery • Cardiac cycle – sequence of contraction and relaxation • Polarized state © 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 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 © 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 49-9 Apply Your Knowledge What two procedures might the medical assistant preform? ANSWER: Electrocardiography and pulmonary function testing What is the term for the depolarization, repolarization, and polarized state sequence? ANSWER: The cardiac cycle © 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 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 © 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 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 not understand – Patients who cannot follow directions – Patients who cannot perform the procedure © 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 49-47 Performing Spirometry (cont.) • Calibration – Daily ~ keep logbook – Calibration syringe • Infection control – Clean after patient testing – Dispose of items appropriately • Results of testing © 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 49-48 Peak Expiratory Flow Rate (PEFR) • Peak flow meter – Reveal narrowing of airways prior to an asthma attack – Physician determines peak flow zones © 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 49-49 Peak Expiratory Flow Rate (PEFR) © 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 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 © 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 49-51 Apply Your Knowledge What is the purpose of PFTs? ANSWER: To evaluate lung volume and capacity What does successful spirometry testing depend on? ANSWER: On proper patient preparation and consistent technique in preforming the procedure and analyzing the results © 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 49-52 Apply Your Knowledge 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 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 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 © 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 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 © 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 49-54 In Summary (cont.) 49.2 the The heart’s conduction system is responsible for 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 © 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 49-55 In Summary (cont.) 49.3 The electrocardiograph consists of the following components: electrodes, amplifier, stylus, leads, and ECG paper 49.4 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 © 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 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 the and A Holter monitor is used to measure the heart’s activity over a 24-hour period This is used when patient has intermittent chest pain or discomfort a normal ECG and stress test © 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 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 © 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 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 © 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 49-59 End of Chapter 49 As the arteries grow hard, the heart grows soft ~ H L Mencken © 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 49-60 Apply Your Knowledge 5260 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 .. .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... in whole or part 49- 5 The Medical Assistant’s Role in Electrocardiography and Pulmonary Function Testing • Medical assistant may perform – Electrocardiography – Pulmonary function tests (PFTs)... part 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