ECGs for Nurses (Essential Clinical Skills for Nurses)

226 Pages·2003·2.19 MB·English

by  Philip Jevon

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.
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Includes bibliographical references and index.
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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