Title NCM 112 RLE MIDTERMS ✅

RD PRS ● If a selected electrode site is excessively hairy, clip the hair using disposable head hair clippers to promote electrode adherence to the patient's skin. ● Wash electrode sites using soap and water and a washcloth. Wipe them with a dry washcloth or gauze pad to roughen the patient's skin, which helps remove its outer layer to facilitate electrical signal transmission. If necessary, clean oily skin using an alcohol pad and allow it to dry. ● Mark electrode sites with indelible marking pen if serial ECGs are likely. ● Apply disposable pre gelled electrodes to inside forearms and to the medial aspects of the ankles or calves; limb leads should be an equal distance from the heart and in about the same place on each limb. Apply the pre gelled electrodes directly to the prepared sites, as recommended by the manufacturer's instructions. Apply disposable electrodes on patient's legs, with lead connections pointing superiorly to guarantee the best connection to the lead wire. ● Apply a pre gelled electrode at each electrode site on the patient's chest. If the patient is female, be sure to apply the chest electrodes under the breast tissue. ● Connect lead wires to the electrodes. Note that the tip of each lead wire is lettered and color-coded for easy identification. ○ white or RA lead wire goes to the right arm, ○ green or RL lead wire to the right leg, ○ red or LL lead wire to the left leg, ○ black or LA lead wire to the left arm, ○ brown or V1 to V6 lead wires to the chest electrodes. ● Instruct patient to relax and breathe normally. Instruct the patient to lie still and not to talk when you record the ECG to minimize artifacts. ● Press the AUTO or START button. The ECG machine records all 12 leads automatically, recording three consecutive leads simultaneously. Some machines have a display screen that allows you to preview waveforms before the machine records them on recording paper. Observe the tracing quality. ● Repeat ECG recording, as needed. ● When ECG machine finishes recording, remove the electrodes and clean the patient's skin. Disconnect the lead wires from the electrodes and dispose of the electrodes, as indicated. ● Return bed to the lowest position to prevent falls and maintain patient safety. ● Remove and discard gloves, if worn. Perform hand hygiene. Put on gloves, as needed. Clean and disinfect reusable equipment according to manufacturer's instructions to prevent the spread of infection. Remove and discard your gloves. Perform hand hygiene. Document the procedure. APPLYING CHEST ELECTRODES To ensure proper placement of chest electrodes, use palpation to locate the correct intercostal space. 1. Palpate the point at which the sternum attaches to the clavicle (suprasternal notch); 2. Palpate down to identify the sternal angle, which is the bony prominence at which the second rib attaches to the sternum. 3. Space below second rib is the second intercostal space. 4. Continue to palpate down patient's sternum, counting the ribs and intercostal spaces to find the appropriate location for the chest electrodes. For accurate test results, apply chest electrodes as follows: V1: Fourth intercostal space at the right border of the sternum V2: Fourth intercostal space at the left border of the sternum V3: Halfway between V2 and V4 V4: Fifth intercostal space at the left midclavicular line V5: In the horizontal plane of V4 at the anterior axillary line (or halfway between V4 and V6, if the anterior axillary line is ambiguous) V6: In the horizontal plane of V4 at the midaxillary line Special Considerations ● During the procedure, instruct the patient to breathe normally. If patient's respirations distort the ECG recording, instruct patient to hold their breath briefly to reduce baseline wander in the tracing. ● If patient has a pacemaker, you can perform an ECG with or without magnet according to the practitioner's orders. Be sure to note the presence of a pacemaker and the use of the magnet on both the ECG strip and in the patient's medical record. ● Record ECG with the patient in the same position each time because different positions may cause differences in the tracings. If another position is required because of the patient's condition, document the position used on the tracing and in the patient's medical record. Documentation 2