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ECGs for Nurses (Essential Clinical Skills for Nurses) PDF

226 Pages·2003·2.19 MB·English
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ECGs for Nurses ECGs for Nurses Philip Jevon RN BSc (Hons) PGCE ENB 124 Coronary Care Nursing Resuscitation Training Officer Manor Hospital Walsall © 2003 by Blackwell Science Ltd Jevon, Philip. a Blackwell Publishing company ECGs for nurses / Phil Jevon. p. ; cm. Editorial offices: Includes bibliographical references and index. Blackwell Science Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK ISBN 0-632-05802-1 (pbk. : alk. paper) Tel:+44 (0) 1865 776868 1. Electrocardiography. 2. Arrhythmia–Nursing. Blackwell Publishing Inc., 350 Main Street, Malden, MA02148-5020, [DNLM: 1. Electrocardiography–Nurses’ Instruction. 2. USA Arrhythmia–prevention & control–Nurses’ Instruction. WG 140 J76w Tel: +1 781 388 8250 2003] I. Title. Blackwell Science Asia Pty, 550 Swanston Street, Carlton, Victoria 3053, Australia RC683.5.E5J48 2003 Tel: +61 (0)3 8359 1011 616.1¢207547–dc21 2003005902 The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and ISBN 0-632-05802-1 Patents Act 1988. Acatalogue record for this title is available from the British Library All rights reserved. No part of this publication may be reproduced, Set in 9/12pt Palatino stored in a retrieval system, or transmitted, in any form or by any by SNPBest-set Typesetter Ltd., Hong Kong means, electronic, mechanical, photocopying, recording or Printed and bound in Great Britain using acid-free paper otherwise, except as permitted by the UK Copyright, Designs and by MPG Books, Bodmin Cornwall Patents Act 1988, without the prior permission of the publisher. For further information on Blackwell Publishing, visit our website: First published 2003 www.blackwellpublishing.com Library of Congress Cataloging-in-Publication Data Contents Foreword vi 8 Cardiac arrhythmias with atrioventricular Acknowledgements ix block 107 1 The conduction system in the heart 1 9 Cardiac arrhythmias associated with cardiac arrest 119 2 Principles of cardiac monitoring 9 10 Recording a 12 lead ECG 131 3 ECG interpretation of cardiac arrhythmias 29 11 Interpreting a 12 lead ECG 145 4 Cardiac arrhythmias originating in the SA 12 Treatment of cardiac arrhythmias 188 node 38 5 Cardiac arrhythmias originating in the atria 57 13 Record keeping 203 6 Cardiac arrhythmias originating in the AV Index 209 junction 73 7 Cardiac arrhythmias originating in the ventricles 89 v Foreword I am delighted to write this foreword for a new and ate their significance and necessary management. This exciting ECG book for nurses. book outlines all arrhythmias in a logical fashion using Coronary heart disease is among the biggest killers a five-stage approach to analysis with examples fol- in the country. More than 1.4 million people suffer lowed by possible effects on the patient, and finally, from angina. 300000 people have a heart attack every treatment. Chapters exploring arrhythmias include the year. More than 110000 people die of heart problems conduction system, principles of monitoring, arrhyth- in England every year (Department of Health 2000). mias originating in the sinoatrial node, atria, atrioven- The risk of death is the highest within the first hour tricular junction, ventricles and heart blocks. These of myocardial infarction and is usually due to arrhyth- chapters will facilitate the development of the practi- mias (NICE 2002). Arrhythmias are commonly experi- tioner’s knowledge of arrhythmias by giving concrete enced by patients with coronary heart disease (Jowett examples of application and practice. & Thompson 2003). It is imperative that nurses not The National Service Framework for coronary heart only correctly identify arrhythmias, but also appreci- disease (2000) has identified a target for thrombolysis vi Foreword to be administered to patients with a myocardial Nurses must take responsibility for their own learning infarction, without contraindications, within 20 and cultivate an enquiring approach to identify any minutes of arrival in hospital. Nurses have an increas- deficits in personal knowledge or skills that require ingly important role to identify patients in this cate- development (Nursing and Midwifery Council 2002). gory as they require urgent attention. These situations The code of conduct stipulates that as a registered require skills in 12 Lead electrocardiogram (ECG) nurse or midwife, one must maintain professional recording and interpretation. ECGs for Nurses has two knowledge and competence (Nursing & Midwifery chapters dedicated to 12 Lead ECGs, one exploring Council 2002b). recording, and the other, interpretation. It is vital for I believe that a knowledgeable nurse, highly skilled nurses to review their skills of ECG recording to ensure in arrhythmia and 12 Lead ECG interpretation and accuracy and thoroughness and include right-sided management, who is not afraid to challenge or indeed leads and posterior leads as, and when, necessary. A admit limitations, works with the multidisciplinary systematic approach is used for 12 Lead electrocar- team to ensure that patients receive the care they diogram analysis and a comprehensive exploration of, deserve. for example, myocardial infarction, bundle branch I congratulate Philip Jevon for his systematic and blocks with a variety of ECG examples are included for very readable approach to ECG interpretation; it is so analysis. often seen as a highly complex and incomprehensible The Nursing and Midwifery Council (2002a) sup- topic. ports lifelong learning for nurses and midwives. It is I hope that you enjoy this book as much as I have, crucial that practitioners keep abreast of new devel- and that you also enjoy your lifelong learning journey opments in practice, treatments and technology. in pursuit of excellence in care. vii Foreword Cynthia Curtis National Institute for Clinical Excellence (2002) Guid- Senior Lecturer ance on the use of drugs for early thrombolysis in the treat- Northumbria University ment of acute myocardial infarction. National Institute of Clinical Excellence, London. Department of Health (2000) National Service Frame- Nursing & Midwifery Council (2002a) Supporting work for Coronary Heart Disease. The Stationery Office, nurses and midwives through lifelong learning. Nursing & London. Midwifery Council Publications, London. Nursing & Midwifery Council (2002b) Code of profes- Jowett, N.I., Thompson, D.R. (2003) Comprehensive sional conduct. Nursing & Midwifery Council Publica- Coronary Care, 3rdedn. Baillière Tindall, Edinburgh. tions, London. viii Acknowledgements Anote of thanks to: for kindly reviewing sections of the text and some of Philips, Medicotest and Medtronic for allowing me the ECGs. The staff on Coronary Care/Osprey Ward to reproduce their images and diagrams. John Hamil- and in Clinical Measurements, Manor Hospital, ton and his colleagues in the Medical Photography Walsall for saving ECGs which have been used in this Department at the Manor Hospital, Walsall for their book. Kevin Morris at Aurum Pharmaceuticals for help with photographs. Dr Alan Cunnington, Consul- supplying the artwork for the treatment algorithms. tant Physician/Cardiologist, Manor Hospital, Walsall Laerdal Medical for supplying four ECG traces. ix

Description:
The first ECG book to be aimed specifically at nurses. This practical, handy-sized guide will be useful for nurses working in all acute areas, as well as general nurses and students learning about ECGs for the first time. Real ECGs are used throughout to supplement the text. Bullet points, diagrams
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