Lippincott Manual of Nursing Practice Series: ECG Interpretation

288 Pages·2007·1.2 MB·English

by  Springhouse

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LIPPINCOTT MANUAL
of NURSING PRACTICE
Series
ECG
INTERPRETATION
◆
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STAFF The clinical treatments described and recom-
mended in this publication are based on re-
Executive Publisher
search and consultation with nursing, medical,
Judith A. Schilling McCann, RN, MSN and legal authorities. To the best of our
knowledge, these procedures reflect currently
Editorial Director
accepted practice. Nevertheless, they can’t be
H. Nancy Holmes
considered absolute and universal recommen-
Clinical Director dations. For individual applications, all recom-
mendations must be considered in light of the
Joan M. Robinson, RN, MSN
patient’s clinical condition and, before admin-
Art Director istration of new or infrequently used drugs, in
Mary Ludwicki light of the latest package-insert information.
The authors and publisher disclaim any re-
Editorial Project Manager sponsibility for any adverse effects resulting
Sean Webb from the suggested procedures, from any un-
detected errors, or from the reader’s misunder-
Editors
standing of the text.
Jennifer Lynn Kowalak,
CarolTurkington © 2008 by Lippincott Williams & Wilkins. All
rights reserved. This book is protected by
Clinical Editor
copyright. No part of it may be reproduced,
Elizabethe Westgard, RN, MSN stored in a retrieval system, or transmitted, in
Copy Editors any form or by any means—electronic, me-
Kimberly Bilotta, Laura Healy, chanical, photocopy, recording, or other-
wise—without prior written permission of the
MarnaPoole, Jenifer Walker
publisher, except for brief quotations embod-
Designers ied in critical articles and reviews and testing
Marsha Biderman, Jan Greenberg, and evaluation materials provided by publish-
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Library of Congress
Editorial Assistants
Cataloging-in-Publication Data
Megan L. Aldinger, Karen J. Kirk,
LindaK. Ruhf ECG interpretation.
p. ; cm. — (Lippincott manual of nursing
Indexer practice series)
Deborah Tourtlotte Includes bibliographical references.
1. Electrocardiography—Handbooks, manuals,
etc. 2. Heart—Diseases—Nursing—Handbooks,
manuals, etc. I. Series.
[DNLM: 1. Electrocardiography—nursing—
Handbooks. WY 49 E17 2008]
RC683.5.E5E252 2008
616.1'207547—dc22
ISBN-13: 978-0-7817-7741-4 (alk. paper)
ISBN-10: 0-7817-7741-0 (alk. paper) 2007005855
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CONTENTS
◆
Contributors and consultants v
Part 1 Reviewing fundamentals 1
1 Cardiac anatomy and physiology 3
2 Understanding ECGs 20
3 ECG monitoring 38
Part 2 Interpreting rhythm strips 47
4 Sinoatrial node arrhythmias 49
5 Atrial arrhythmias 62
6 Junctional arrhythmias 82
7 Ventricular arrhythmias 92
8 Atrioventricular blocks 114
9 Electrolyte disturbances 125
Part 3 Interpreting 12-lead ECGs 133
10 Normal 12-lead ECG 135
11 Electrical axis determination 148
12 Acute coronary syndromes 152
13 Bundle-branch block, enlargement, and
hypertrophy 168
Part 4 Understanding the effects of treatment 183
14 Pharmacologic treatments for arrhythmias 185
15 Nonpharmacologic treatments for
arrhythmias 194
Part 5 Reviewing rhythm strips 223
16 Practice strips 225
Appendices and index 251
Rapid reference to major arrhythmias 253
ACLS algorithms 260
Cardiac drug overview 268
Selected references 274
Index 275
iii
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CONTRIBUTORS AND
CONSULTANTS
◆
Gary J. Arnold, MD Shirley Lyon Garcia, RN, BSN
Associate Professor Nursing Program Director, PNE
College of Nursing and Allied Health McDowell Technical Community College
Professions Marion, N.C.
University of Louisiana at Lafayette
Charla K. Hollin, RN, BSN
Cheryl A. Bean, APRN, BC, DSN, ANP, Nursing Program Director
AOCN Rich Mountain Community College
Associate Professor/Adult Nurse Practitioner Mena, Ark.
Indiana University School of Nursing
Indianapolis Shelley Yerger Huffstutler, RN, DSN,
CFNP, GNP
Mary Ann Boucher, APRN, BC, ND Associate Professor and Director, FNP Program
Assistant Professor of Nursing University of Alabama at Birmingham
University of Massachusetts Dartmouth School of Nursing
Peggy Bozarth, RN, MSN Mary T. Kowalski, RN, BA, MSN
Professor Director Vocational Nursing and Health Career
Hopkinsville (Ky.) Community College Programs
Cerro Coso Community College
Janie Choate, PA-C, MAT, BS, BA Ridgecrest, Calif.
Adjunct Faculty
University of the Sciences Grace G. Lewis, RN, MS, BC
Philadelphia Assistant Professor of Nursing
Georgia Baptist College of Nursing of
Laura M. Criddle, RN, MS, CCNS, CEN Mercer University
Doctoral Student Atlanta
Oregon Health & Science University
Portland Patricia J. McBride, RN, MSN, CIC
Infection Control Manager
Diane Dixon, PA-C, MA, MMSc Bryn Mawr (Pa.) Hospital
Assistant Professor and Academic Coordinator
University of South Alabama Cynthia A. Prows, RN, MSN, CNS
Department of Physician Assistant Studies Clinical Nurse Specialist
Mobile Children’s Hospital Medical Center
Cincinnati
v
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Betty E. Sims, RN, MSN
Nurse Consultant
Board of Nurse Examiners
Austin, Tex.
Adjunct Instructor
St. Philip’s College
San Antonio, Tex.
Sheryl Thomas, RN, MSN
Nurse Instructor
Wayne County Community College
Detroit
Dan Vetrosky, PA-C, MEd, PhD(c)
Assistant Professor
University of South Alabama
Mobile
Colleen R. Walsh, RN, MSN, ACNP-BC,
CS, ONC
Faculty, Graduate Nursing
University of Southern Indiana School of
Nursing & Health Professions
Evansville
vi CONTRIBUTORS AND CONSULTANTS
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PART 1
◆
Reviewing fundamentals
1
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1
CCAARRDDIIAACC AANNAATTOOMMYY
2
AANNDD PPHHYYSSIIOOLLOOGGYY
Correct electrocardiogram (ECG) LOCATION AND STRUCTURE
interpretation is a challenge for any The heart lies at an angle in the chest,
practitioner. With a good under- behind the sternum in the mediastinal
standing of ECGs, you’ll be better cavity, or mediastinum. It’s located be-
able to provide expert care to your tween the lungs, in front of the spine.
patients. For example, when you’re The top of the heart, called the base,
caring for apatient with an arrhythmia lies just below the second rib. The
or a myocardial infarction, an ECG bottom of the heart, called the apex,
waveform can help you quickly tilts forward and down toward the
assesshiscondition and begin life- leftside of the body and rests on the
saving interventions. diaphragm. (See The heart’s location,
To build ECG skills, start with the page 4.)
basics covered in this chapter—an An infant’s heart is positioned
overview of the heart’s anatomy more horizontally in the chest cavity
andphysiology. than an adult’s heart. As a result, the
apex is at the fourth intercostal space.
Until age 4, the apical impulse is to
Cardiac anatomy
the left of the midclavicular line. By
◆
age 7, the child’s heart is located in
The heart is a hollow muscular organ theadult position.
that works like a mechanical pump. The heart varies in size, depend-
Itdelivers oxygenated blood to the ingon a person’s body size, but it’s
bodythrough the arteries. When roughly 5” (12 cm) long and 31⁄ ”
4
blood returns through the veins, (8cm) wide, or about the size ofa
theheart pumps it to the lungs to be fist.The heart’s weight, typically 9 to
reoxygenated. In this section you’ll 12 oz (255 to 340 g), varies depending
find descriptions of the location and on the person’s size, age, sex, and ath-
structure of the heart, how blood letic conditioning. An athlete’s heart
flows through the heart, and the usually weighs more than average,
coronary blood supply. and an elderly person’s heart usually
weighs less than average.
3
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THE HEART’S LOCATION
The heart lies within the mediastinum,a cavity that contains the tissues and organs that
separate the two pleural sacs.In most people,two-thirds of the heart extends to the left
ofthe body’s midline.
Clavicle
Sternum
Rib
Heart
Xiphoid process
12th thoracic
vertebra
●
As a person ages, his heart usually the epicardium (the outermost
becomes slightly smaller and loses its layer) is made of squamous epithelial
strength and efficiency. People with cells overlying connective tissue
●
hypertension may experience a mod- the myocardium (the middle and
erate increase in left ventricular wall thickest layer) is the largest portion of
thickness. As the heart ages, the the heart’s wall and contracts with
myocardium becomes more easily each heartbeat
●
irritated and extrasystoles may occur, the endocardium (the heart wall’s
along with sinus arrhythmias and si- innermost layer) consists of a thin
nus bradycardias. In addition, in- layer of endothelial tissue that lines
creased fibrous tissue infiltrates the the heart valves and chambers. (See
sinoatrial (SA) node and internodal Layers of the heart wall.)
atrial tracts, which may cause atrial
fibrillation andflutter. Pericardium
By age 70, cardiac output at rest The pericardium is a fluid-filled sac
has diminished by 30% to 35% in that envelops the heart and acts as a
many people. tough, protective covering. It consists
of the fibrous pericardium and the
Heart wall serous pericardium. The fibrous
The heart wall is made up of three pericardium is made of tough, white
layers: tissue, which fits loosely around the
heart and protects it. The serous
4 CARDIAC ANATOMY AND PHYSIOLOGY