ELECTROCARDIOGRAM SKILLS LAB DEFINITION: Records the electrical activity generated in the heart during the cardiac cycle. RATIONALE: 1. To provide grounds for the diagnosis of cardiac arrhythmias, arteriosclerotic heart disease, cardiac enlargement, electrolyte abnormalities, and myocardial infarction. 2. To assess the status of a client in a life threatening situation as a basis for medical or nursing action. 3. To provide a visual image of the heart’s rhythm. EQUIPMENT: 1. ECG Machine – machine capable of transcribing to graph paper the electrical activity of the heart. 2. Electrodes – placed at strategic positions on the extremities and chest precordium and is capable of conducting electrical activity from the heart to the ECG machine. 3. KY jelly / electrode paste or alcohol swabs – ensures good contact between the clients skin and the electrode. 4. ECG paper – a graph paper with horizontal & vertical axes. PLANNING & IMPLEMENTATION: 1. Elicit and record the clients : ♥ age ♥ Sex ♥ Height ♥ Weight ♥ blood pressure ♥ symptoms and medications ♥ unusual position of the client during examination ♥ presence of thoracic deformities, amputation, respiratory distress, or muscle tremors. * Facilitates interpretation of the EKG/ECG 2.Ask the client if he or she has ever had an EKG before. Explain the procedure will take only 10 to 15 minutes and is painless. * Simple explanation reduces the client’s anxiety. If the client has had an ECG, the old ECG should be obtained for comparison. 3. Assist the client to assume a supine position. * Facilitates good recording. 4. Close the door and bedside curtains. * Provide privacy for the client 5. Secure electrodes on the flat inner aspects of the clients wrists and ankles with extremity straps adjusted to hold the electrodes firmly in place. Use electrode paste/alcohol swabs/KY jelly between the electrodes and the clients skin. * If the straps are places too tightly, circulation to the extremity could be compromised. Electrode paste or alcohol swabs ensures good contact between the clients skin and the electrode. 6. Attach the chest leads. V1 – at the 4th ICS at the right sternal border (RED) V2 – at the 4th ICS at the left sternal border (YELLOW) V3 – at the midpoint between V1 and V4 (GREEN) V4 – at the 5th ICS at the midclavicular line (BROWN) V5 – at the level of V4, at the left anterior axillary line (BLACK) V6 – at the level of V4, at the left midaxillary line. (VIOLET) * The recording will vary according to the placement of the leads. Frontal and Horizontal Plane Lead Diagram 7. Turn on the lead selection switch to record all 12 leads. * Promotes the client’s comfort. 8. Removes the leads and any paste that may be remaining. * Communicates to the other members of the health care team and contributes to the legal record by documenting the care given to the client. 9. Place the ECG results on the chart and note the time and condition of the client.