Cardiac-monitoring.docx

CARDIAC MONITORING

A Slight Glimpse for the Eye The cardiac monitoring is a device that shows the electrical and pressure waveform of the cardiovascular system for measurement and treatment. Parameters specific to respiratory function can also be measured. Because electrical connection are made between the cardiac monitoring and the patient, it is kept at the patient bedside. Furthermore, Long-term cardiac monitoring is best suited for patients with infrequent intermittent symptoms possibly related to arrhythmia, or those where an infrequent “silent” arrhythmia is sought. Although syncope is a logical first application of this technology, many other clinical disease states stand to benefit from the knowledge gained from prolonged monitoring. This includes atypical epilepsy, where seizures may be evidence of recurrent cerebral hypo-perfusion in conjunction with syncope, mistaken as a primary neurological event. Brief Description 

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The term “cardiac monitoring” refers to continuous monitoring of the heart done using probes placed on a patient’s skin. This process, known as electrocardiography, is painless and non-invasive. These monitors are useful in a variety of instances, especially if utilized while a patient is suffering from a heart attack. A cardiac monitor will emit a loud alarm if the patient’s heart rate drops too low, or soars too high. This alarm alerts the medical professionals, after which they attempt to stabilize the patient’s heart rate. The monitor provide a visual display of many patient parameters. It can be set to sound an alarm if any parameter changes outside of an expected range determined by the physician. Continuous cardiac monitoring is an important tool in the clinical assessment of patients with a variety of conditions. It allows the detection of changes in heart rate, rhythm and conduction, and is essential in the detection of life threatening arrhythmias. This is achieved using a cardiac monitor, connected to a cable lead and skin electrodes, which captures the electrical activity predominently through a single view (commonly lead II). Parameter to be monitored may include, but are not limited to, electrocardiogram, noninvasive blood pressure, intravascular pressure, cardiac output, arterial blood oxygen saturation, and blood temperature. Equipment required for continuous cardiac monitoring includes the cardiac monitor, cables and disposable supplies such as electrode patches, pressure transducer a pulmonary artery catheter (Swanz-Ganz Catheter), and an arterial blood saturation probe.

Criteria for Monitoring Patients with these conditions should be monitored for 24 to 48 hours:  Low probability of myocardial infarction (MI), to rule out MI

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Any hemodynamically stable dysrhythmia Before and after coronary angiography in patients with stable angina and no heart failure Cardiac contusion without hemodynamic instability Neurologic changes such as transient ischemic attack or stroke Acute medical illness with stable cardiac disease and no ischemia Mild heart failure without shock (Killip Class I)

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Postoperative surgery patients with cardiac history but no active ischemia Post-permanent pacemaker placement Overdose or drug toxicity without dysrhythmia Syncope in patients without heart failure or respiratory failure Pericardial effusion or any suspected cardiac trauma Electrocution

Patients with these conditions should be monitored for 48 to 72 hours:  Unstable angina: rule out myocardial infarction  Hemodynamically stable myocardial infarction  Any hemodynamically unstable dysrhythmia, not including potentially lethal dysrhythmias that require continuous cardiac monitoring  Before and after percutaneous coronary intervention in stable patients  During initiation of type I or type III antiarrhythmia agents for dysrhythmias  Major ischemic or hemorrhagic stroke with potential for dysrhythmia  Acute medical illness with cardiac disease  Moderate heart failure without shock (Killip Class II)  Postoperative surgery in patients with angina, ST-segment and T-wave changes, myocardial ischemia on preoperative stress test, dysrhythmia, hypotension, or heart failure  Respiratory failure as defined by hypoxemia, hypercapnea, uncompensated respiratory acidosis with pH less than 7.35, clinical evidence of severe respiratory distress  Overdose or drug toxicity with dysrhythmia or high potential for dysrhythmia  Syncope in patients with heart failure or respiratory failure  History of status epilepticus or seizure disorder and risk for sudden death Purposes 

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The cardiac monitor continuously displays the cardiac electrocardiogram (EKG) tracing. Additional monitoring components allow cardiovascular pressures and cardiac output to be monitored and displayed as required for the diagnosis and treatment. Oxygen saturation of the arterial blood can be monitored continuously.

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Most commonly used in the emergency rooms and critical care areas, bedside monitors can be interconnected to allow for continual observation of several patients from a central display. Continuous cardiovascular and pulmonary monitoring allows for prompt identification and initiation of treatment

a. Heart Rate - This count the number of beats the heart is taking per minute. - This graph shows a line that represent one or more reading from an electrocardiogram (ECG) and the number counts the beats per minute b. Blood Pressure - Monitor can measure blood pressure in 2 different ways. a) The tea member can use a cuff that work the same way the one used in the ward. b) They can get an immediate measurement of the blood pressure at every heartbeat by inserting a small device into the blood vessel to provide a constant measurement. c. Pressure in the Brain( intracranial pressure) - A probe can be inserted in the brain to measure this pressure will help the doctor provide therapist to reduce it - Acceptable value = up to 20mmhg. d. Oxygen Level Saturation - Monitoring can detect how much oxygen is in the blood. Normal value is 95 -1000 % e. Respiration - Resting adult typically breaths 12 to 20 times a minute (average of 16)

Preparation 1. 2. 3. 4. 5.

The site selected for electrodes placement on the skin will be shaved and cleaned causing surface abrasion for the better contact between the skin and electrode. The electrode will have a layer of gel protected by a film, which is removed prior to placing the electrode to the skin. Electrodes patches will be placed near or on the right arm, right leg, left arm, left leg, and the center left side of the chest The cable will be connected to the electrodes patches for the measurement of five-head electrocardiogram. If invasive blood pressure is being measured, a blood pressure cuff will be placed around the patient’s arm or leg. The blood pressure cuff will be set to inflate manually

or automatically, if manual inflation is chosen, the cuff will only inflate at the prompting of the health care provider, after which a blood pressure will be displayed. During automatic operation, the blood pressure cuff will inflate at timed intervals and the display will update at the end of each measurement. Disposable pressure transducer require a references to atmosphere, called zeroing (calibrating), which is completed before monitoring patient pressures. This measurement will occur once the patient is comfortably positioned since the transducer must be level with the measurement point. The pressure transducer will then be connected to the indwelling catheter. It may be necessary for as many as four or five pressure transducer to be connected to the patient. The arterial blood saturation probe will be placed on the finger, toe, ear, or nasal septum of the patient, providing as little discomfort as possible, while achieving a satisfactory measurement.

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Nursing Responsibilities 1.

The provider will confirm that the monitoring is detecting each heartbeat by taking an apical pulse and comparing the pulse to the digital display. The upper and lower alarm limits should be set according to physician orders, and the alarm activated. A printout may be recorder for the medical record, and labelled with patient name, room, number, date, time, and interpretation of the strip. Maintenance and replacement of the disposable component may be necessary as frequent as every eight hours, or as required to maintain proper operation. The arterial saturation probe can be repositioned to suit patient comfort and to obtain a tracing. All connection will be treated in a gentle manner to avoid disruption of the signal and to avoid injury to the patient. Alarm should never be ignored or turned off

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Basic Escort Skill Set -

Basic life support, the must hold a current, facility endorsed BLS accreditation that include the use of AED. Recognition and management of the deteriorating patient. Assessment and management of angina/ angina equivalent. Basic cardiac rhythm interpretation, a nurse should or must know how to recognise VT/TF and other arrhythmias that is life threatening. Management of the infusion pump, a nurse should demonstrate the ability to adjust flow rates if required and troubleshoot pump function.

Advance Escort Skill Set

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Management of IV medication requiring titration Airway Management Administration of ALS drugs Cardiac defibrillation Management of temporary cardiac pacemaker

REPORT in MICU (Cardiac Monitoring) Submitted by: Denise Pagay Susan Solis Marc Sabado Tabladillo Kimberly

Submitted to: Ms. Rona Marie Bergonia

Clinical Instructor: Mr. Jayflor Ronquillo