SCRIPT FOR ECG

INTRODUCTION:
Good day ma’am! I am from BSN
3A/3B, a student nurse of DAVAO ORIENTAL
STATE UMIVERSITY. This video I will be
going to perform another return demonstration
which is about on Electrocardiography or
ECG.
PURPOSE:
The purpose of ECG is to look for the cause of
chest pain, to identify irregular heartbeats, to
evaluate problems which may be heart-related
such as severe tiredness, shortness of breath,
dizziness, or fainting, and to determine the
overall health of the heart.
PROCEDURES:
The first procedure is to verify the order for an
ECG on the patient’s medical record. The
rationale for this is to ensure that the correct
intervention is performed on the correct
patient.
ACTION: (look the patient’s medical record)
Second is to gather all equipment and bring to
bedside. The reason for this is save time and
facilitates accomplishment of the procedure.
ACTION: (prepare all equipment and bring to
bedside)
Next, Perform hand hygiene and put on PPE,
if indicated. Hand hygiene and PPE prevent
the spread of microorganisms. PPE is required
based on transmission precautions.
ACTION: (perform handwashing)
Then, Identify the patient by using two
identifiers such as asking the patient’s name
and the date of birth, and also by looking the
name band that found in the wrist, the
rationale for this is to ensure that the right
patient receives the right intervention and it
helps to prevent errors.
ACTION: (ask the patient) hi sir good
afternoon ako d I c ako ang
student nurse nimo karung adlawa.
Sir naa lang ko ipangutana nimo ok r aba sir?
unsa pangalan sir nimo sir? Edad?
(look the name band)
After that, close the curtains around bed and
close the door to the room to ensure the
patients privacy. Then explain the procedure
to the patient and ask the patient about
allergies. In doing this the explanation can
relieve anxiety to the patient and the patient
will cooperate during the procedure, and also
the possible allergies may exist related to
adhesive on ECG leads.
ACTION: (close curtains and door); sir ang
buhaton na procedure karun sa imoha is mag
conduct og ECG or electrocardiography. Kini
na test sir kay e record niya ang heart
electrical activity nimo, ayaw kabalaka sir dili
mani siya makacuryente og walay kuryente
mosulod sa imo lawas. Ok ra ba sir?
Kini pd na test sir magdugay ni siya mga 5
minutes. Ok r aba ta ana sir?
Next to that is place the ECG machine close to
the patient’s bed, and plug the power cord into
the wall outlet. In doing this is that having
equipment available it saves time and
facilitates accomplishment of the task
ACTION: (place ECG machine close to the
patients bed)
Then, if bed is adjustable, raise bed to
comfortable working height, usually elbow
height of the caregiver. The rationale for this is
that the proper height of bed can prevents
back and muscle strain.
Since our bed is not adjustable so we do not
need to adjust it and we still use it.
ACTION:
Next, we need to position the patient; the
patient will lie supine in the center of the bed
with the arms at the sides. Raise the head of
the bed, if necessary, to promote comfort.
Then, Expose the patient’s arms and legs, and
drape appropriately. Encourage the patient to
relax the arms and legs. If the bed is too
narrow, place the patient’s hands under the
buttocks to prevent muscle tension. Also use
this technique if the patient is shivering or
trembling. Make sure the feet do not touch the
bed’s footboard. The rationale for this is to
help increase patient comfort and will produce
a better tracing. Having the arms and legs
relaxed minimizes muscle trembling, which
can cause electrical interference.
ACTION: (assess the patient position and
expose the arms and legs then drape)
Sir e relax lang ang arms and legs nimo sir ha,
ayaw lang e touch imoha tiil diria sa footboard
sir ha.
After positioning the patient select flat and
fleshy areas on which to place the electrodes.
Avoid muscular and bony areas. If the patient
has an amputated limb, choose a site on the
stump. The rationale for this is the tissue
conducts the current more effectively than
bone, producing a better tracing.
ACTION: (select flat areas for the placement
of electrodes)
Then, if an area is excessively hairy, clip the
hair. Do not shave hair. Clean excess oil or
other substances from the skin with soap and
water and dry it completely. The reason for
this is shaving causes micro abrasions on the
chest skin. Oils and excess hair interfere with
electrode contact and function. Alcohol,
benzoin, and antiperspirant are not
recommended to prepare the skin.
In my case the chest of my client is not hairy,
so now let’s proceed to the next procedure.
NO ACTION:
Now let’s do the Lead placement. Apply the
limb lead electrodes. The tip of each lead wire
is lettered and color-coded for easy
identification. The white (or RA) lead goes to
the right arm; the green (or RL) lead to the
right leg; the red (or LL) lead to the left leg; the
black (or LA) lead to the left arm. Peel the
contact paper off the self-sticking disposable
electrode and apply directly to the prepared
site, as recommended by the manufacturer.
Position disposable electrodes on the legs with
the lead connection pointing superiorly. The
rationale for this is having the lead connection
pointing superiorly guarantees the best
connection to the lead wire.
ACTION: (placing the lead) the white lead to
the right arm, the black lead to the left arm,
the green lead to the right leg and the red lead
to the left leg.
Then connect the limb lead wires to the
electrodes. Make sure the metal parts of the
electrodes are clean and bright. The rationale
for this is dirty or corroded electrodes prevent
a good electrical connection.
ACTION: (connect the limb lead wires to the
electrodes)
After that Expose the patient’s chest. Apply the
precordial lead electrodes. The tip of each
lead wire is lettered and color-coded for easy
identification. The brown (or V1 to V6) leads
are applied to the chest. Peel the contact
paper off the self-sticking disposable electrode
and apply directly to the prepared site, as
recommended by the manufacturer. The
rationale for this is the proper lead placement
is necessary for accurate test results.
ACTION: (placement of precordial lead
electrodes)
V1: Fourth intercostal space at right sternal
border
• V2: Fourth intercostal space at left sternal
border
• V3: Halfway between V2 and V4
• V4: Fifth intercostal space at the left
midclavicular line
• V5: Fifth intercostal space at anterior axillary
line (halfway between V4 and V6)
• V6: Fifth intercostal space at midaxillary line,
level with V4
Next, connect the precordial lead wires to the
electrodes. Make sure the metal parts of the
electrodes are clean and bright. The reason
for this is the dirty or corroded electrodes
prevent a good electrical connection.
ACTION: (connect the precordial lead wires to
the electrodes)
After the application of all the leads, make
sure the paper-speed selector is set to the
standard 25 m/second and that the machine is
set to full voltage. The rationale for this is the
machine will record a normal standardization
mark—a square that is the height of 2 large
squares or 10 small squares on the recording
paper.
ACTION: (set the machine) assuming this is
our machine
Next, If necessary, enter the appropriate
patient identification data into the machine. In
doing this is to allows for proper identification
of the ECG strip.
ACTION: (enter the identification data of the
patient)
Then, ask the patient to relax and breathe
normally. Instruct the patient to lie still and not
to talk while you record the ECG. The reason
for this is that lying still and not talking
produces a better tracing.
ACTION: sir mag pahibalo lang ko noh na
mag relax lang ka sir then ginhawa lang sir
kanang normal lang na ginahawa nimo. Then,
Higda lang sa ka dihaa sir og dili ka pwede
mag estorya during sa recording sa ECG. Ok
ra ba ta ana sir?
After that, press the AUTO button. Observe
the tracing quality. The machine will record all
12 leads automatically, recording three
consecutive leads simultaneously. Some
machines have a display screen so you can
preview waveforms before the machine
records them on paper. Adjust waveform, if
necessary. If any part of the waveform extends
beyond the paper when you record the ECG,
adjust the normal standardization to half
standardization and repeat. Note this
adjustment on the ECG strip, because this will
need to be considered in interpreting the
results. The rationale for this is the observation
of tracing quality allows for adjustments to be
made, if necessary. Notation of adjustments
ensures accurate interpretation of results.
ACTION: (press the auto button, observe the
tracing, and adjust waveform)
When the machine finishes recording the 12-
lead ECG, remove the electrodes and clean
the patient’s skin, if necessary, with adhesive
remover for sticky residue. In doing the
removal and cleaning promote patient comfort.
ACTION: (remove the electrodes and clean
the patient;s skin with adhesive remover)
After disconnecting the lead wires from the
electrodes, dispose of the electrodes. Return
the patient to a comfortable position. Lower
bed height and adjust head of bed to a
comfortable position. The rationale for this is
the proper disposal deters the spread of
microorganisms, promotes patient comfort and
promotes patient safety.
ACTION: (dispose the electrodes; return the
patient to a comfortable position by lower the
bed height and adjust head of bed to a
comfortable position)
Next, clean ECG machine, per facility policy. If
not done electronically from data entered into
machine, label the ECG with the patient’s
name, date of birth, location, date and time of
recording, and other relevant information, such
as symptoms that occurred during the
recording. The rationale for this cleaning
equipment between patient uses decreases
the risk for transmission of microorganisms.
Accurate labeling ensures the ECG is
recorded for the correct patient.
ACTION: (clean ECG machine, label ECG
with patient’s name, date of birth, location,
date and time of recording and other relevant
information, such as symptoms that occurred
during the recording)
After that, remove additional PPE, if used and
perform hand hygiene. The rationale for this is
that removing PPE properly reduces the risk
for infection transmission and contamination of
other items. Hand hygiene prevents
transmission of microorganisms.
ACTION: (remove PPE like gloves and
perform hand hygiene)That’s end on my
Return Demonstration about how to do the
electrocardiography. Thank you