Electrocardiogram (ECG/EKG) : Topic Outline

Responses to Alterations /Problems and Its Pathophysiologic Basis in Life Threatening
Conditions, Acutely Ill

Electrocardiogram (ECG/EKG)
Topic Outline
1. Definition and Introduction
2. Activating prior knowledge
3. Overview of Anatomy and Physiology
4. Principles and Concepts
5. Discussion
6. Proper procedure of Electrocardiogram
7. Summary
Learning Outcomes
After studying this unit, you will be able to:
 Define the importance and purpose of Electrocardiogram
 Know the Principles and Concepts of Electrocardiogram
 Perform the proper procedure of performing Electrocardiogram
Introduction
An electrocardiogram (ECG) is one of the simplest and fastest tests used to evaluate the heart. Electrodes
(small, plastic patches that stick to the skin) are placed at certain spots on the chest, arms, and legs. The electrodes
are connected to an ECG machine by lead wires. The electrical activity of the heart is then measured, interpreted, and
printed out. No electricity is sent into the body.
An electrocardiogram — abbreviated as EKG or ECG — is a test that measures the electrical activity of the
heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to
squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower
chambers.
The right and left atria or upper chambers make the first wave called a “P wave" — following a flat line when
the electrical impulse goes to the bottom chambers. The right and left bottom chambers or ventricles make the next
wave called a “QRS complex." The final wave or “T wave” represents electrical recovery or return to a resting state for
the ventricles. Changes in an ECG can be a sign of many heart-related conditions.
It can determine or detect:

 Abnormal heart rhythm (arrhythmias)
 If blocked or narrowed arteries in your heart (coronary artery disease) are causing chest pain or a heart
attack
 Whether you have had a previous heart attack
 How well certain heart disease treatments, such as a pacemaker, are working
We may perform an ECG if patient have any of the following signs and symptoms provided with doctor’s order:
 Chest pain
 Dizziness, lightheadedness or confusion
 Heart palpitations
 Rapid pulse
 Shortness of breath
 Weakness, fatigue or a decline in ability to exercise
Activating Prior Knowledge

Answer the quiz on electrical conduction system of the heart by clicking the following link
https://www.registerednursern.com/quiz-on-the-electrical-conduction-system-of-the-heart-anatomy-pathophysiology/
make sure to answer all the questions and put an emphasis on answers and rationale.
Overview of Anatomy and Physiology of Electro-Cardio System
In the simplest terms, the heart is a pump made up of muscle tissue. Like all muscle, the heart needs a source of
energy and oxygen to function. The heart's pumping action is regulated by an electrical conduction system that
coordinates the contraction of the various chambers of the heart.
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An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or SA node). This is a small mass
of specialized tissue located in the right upper chamber (atria) of the heart. The sinus node generates an electrical
stimulus regularly, 60 to 100 times per minute under normal conditions. The atria are then activated. The electrical
stimulus travels down through the conduction pathways and causes the heart's ventricles to contract and pump out
blood. The 2 upper chambers of the heart (atria) are stimulated first and contract for a short period of time before the 2
lower chambers of the heart (ventricles).
The electrical impulse travels from the sinus node to the atrioventricular node (also called AV node). There, impulses
are slowed down for a very short period, then continue down the conduction pathway via the bundle of His into the
ventricles. The bundle of His divides into right and left pathways, called bundle branches, to stimulate the right and left
ventricles.
Normally at rest, as the electrical impulse moves through the heart, the heart contracts about 60 to 100 times a
minute, depending on a person's age.
Each contraction of the ventricles represents one heartbeat. The atria contract a fraction of a second before the
ventricles so their blood empties into the ventricles before the ventricles contract.
The P wave in an ECG complex indicates atrial depolarization. The QRS is responsible for ventricular depolarization
and the T wave is ventricular repolarization.
Read
1. Harding, M.M., et al. (2020) Lewis’s medical-surgical nursing: assessment and management of clinical
th
problems. 11 edition.
th
2. Brunner & Suddarths. (2018). Textbook of Medical Surgical Nursing, 14 edition.
Demonstration Link (Electrocardiogram)
View this video demonstration by clicking the following link to learn more about performing electrocardiogram:
https://www.youtube.com/watch?v=1k4B_fIX_t0
Guidelines on Return Virtual Return Demonstration

Equipment’s:
1. 12 Lead ECG
2. Clean gloves
3. Alcohol swab
PROCEDURE RATIONALE
1. Identify the Patient To accurately provide the correct management to
the right patient
2. Explain the procedure to the patient To establish rapport
3. Provide privacy To decrease patient anxiety and to maintain
client’s dignity
4. Obtain consent To protect the nurse and the client
5. Perform hand washing To prevent the spread of infection
6. Gather all equipment’s needed For a time wise and well-organized procedure
7. Position the client in a supine position or semi fowlers To provide a comfortable position and well
position visualized area
8. Remove any jewelry or other metal objects that may Any metal objects may interfere with the electro-
interfere with the test. conductive properties of the ECG
9. Have the patient remove clothing above the waist and don
a cloth gown opening to the front. Expose the arms and legs.
For proper electrode adhesion.
If necessary shave the electrode areas or clean the exposed
skin with alcohol if needed
MACHINE PREPARATION: (if applicable)
Connect the portable unit to an exam room computer’s USB For a time wise and well-organized procedure
port. Snap lead attachment into base of portable unit.
10. Chest (Precordial) Electrodes and Placement The limb leads can also be placed on the upper
 V1 - Fourth intercostal space on the right sternum arms and thighs. However, there should be
 V2 - Fourth intercostal space at the left sternum uniformity in your placement. For instance, do not
 V3 - Midway between placement of V2 and V4 attach an electrode on the right wrist and one on
 V4 - Fifth intercostal space at the midclavicular line the left upper arm.
 V5 - Anterior axillary line on the same horizontal level For female patients, place leads V3-V6 under the
as V4 left breast.
 V6 - Mid-axillary line on the same horizontal level as V4 Do not use nipples as reference points in placing
and V5 electrodes for both men and women as nipple
locations vary from one person to another
11. Limb (Extremity) Electrodes and Placement
 RA (Right Arm) - Anywhere between the right shoulder
and right elbow
 RL (Right Leg) - Anywhere below the right torso and
above the right ankle
 LA(Left Arm) - Anywhere between the left shoulder and
the left elbow
 LL (Left Leg) - Anywhere below the left torso and above
the left ankle
12. Instruct the patient to lie still and minimize talking Sudden force or movement may alter the result
13. Press the start button on the machine and wait until the
ECG paper produce the correct reading During the procedure, record any clinical signs
(e.g. chest pain) in the notes or on the ECG
(you may repeat the procedure once you notice any technical
tracing itself.
problem with the ECG paper)
14. Label the ECG paper with patient details To ensure safety of ECG result
14. Remove electrodes and position the patient in a
To promote patient’s dignity
comfortable position
15. Perform hand washing and Document the procedure Provides precise baseline data in the care of the
client.
Sample ECG result
Sample of ECG Machine
Summary
The standard 12-lead electrocardiogram (ECG) is one of the most commonly used medical studies in the
assessment of cardiovascular disease. It is the most important test for interpretation of the cardiac rhythm, detection
of myocardial ischemia and infarction, conduction system abnormalities, pre-excitation, long QT syndromes, atrial
abnormalities, ventricular hypertrophy, pericarditis, and other conditions.
Readings and References
Harding, M.M., et al. (2020) Lewis’s medical-surgical nursing: assessment and management of clinical
th
problems. 11 edition.
th
Brunner & Suddarths. (2018). Textbook of Medical Surgical Nursing, 14 edition.

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Electrocardiogram (ECG/EKG) : Topic Outline

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Responses to Alterations /Problems and Its Pathophysiologic Basis in Life Threatening

Conditions, Acutely Ill

It can determine or detect:

Activating Prior Knowledge

Demonstration Link (Electrocardiogram)

Guidelines on Return Virtual Return Demonstration

Sample ECG result

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