Course Overview: This course begins with a discussion of the physiology of cardiac conduction, and then covers the basics of how to read an EKG strip, and the normal components of the EKG waveform. We will then examine b
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Course Overview: This course begins with a discussion of the physiology of cardiac conduction, and then covers the basics of how to read an EKG strip, and the normal components of the EKG waveform. We will then examine basic cardiac dysrhythmias, including atrial and ventricular dysrhythmias, and blocks. Finally, selected nursing diagnoses for patients with dysrhythmias will be offered, along with suggested associated nursing interventions. See Objectives for specific course goals.
Course Objectives
Upon completion of this program the learner should be able to:
• Identify basic normal EKG waveform morphology.
• Describe the normal physiology of cardiac conduction.
• Distinguish between basic dysrhythmias.
• Describe the physiological consequences and treatments of these basic dysrhythmias.
Target Audience
• The target audience for this course is second level nursing students at Dodge City Community College Department of Nursing.
According to the current literature, there is firm support for nurses becoming competent in cardiac monitoring and dysrhythmia identification. According to Beery (1998), over the last few years nurses outside of critical care have been asked to take care of patients with cardiac dysrhythmias. These nurses need to have some basic education regarding the cardiac conditions of their patients. They must also have an understanding of the fundamentals of cardiac monitoring, and dysrhythmia interpretation. It is essential that institutions have emergency policies and procedures in place, along with a continuing competency education program and yearly refresher programs. The programs should include validation of dysrhythmia interpretation skills and problem solving of case studies.
Nurses have significant diagnostic influence in the areas of cardiac rhythm monitoring and dysrhythmia identification (Hebra, 1994). It is essential that nurses who care patients at risk for cardiac dysrhythmias have a thorough understanding of accurate electrode placement. They must also use current principles when determining the optimal leads to use in monitoring specific types of dysrhythmias.
EKG monitoring is becoming more common in both inpatient and outpatient care settings (Scrima, 1997). Nurses are asked to be responsible for cardiac patients, including monitoring and interpreting cardiac dysrhythmias. They must develop critical thinking skills that help them evaluate the significance of these dysrhythmias. A thorough understanding of cardiac anatomy, physiology and properties can provide a framework for understanding and interpreting cardiac rhythms.
Physiology of Cardiac Conduction
In an adult with a healthy heart, the heart rate is usually about 72 beats per minute.
The excitatory and electrical conduction system of the heart is responsible for the contraction and relaxation of the heart muscle. The sinoatrial node (SA node) is the pacemaker where the electrical impulse is generated. This node is located along the posterior wall of the right atrium right beneath the opening of the superior vena cava. It is crescent shaped and about 3 mm wide and 1 cm long.
The impulse travels from the SA node through the internodal pathways to the atrioventricular node (AV node). The AV node is responsible for conduction of the impulse from the atria to the ventricles. The impulse is delayed slightly at this point to allow complete emptying of the atria before the ventricles contract.The impulse continues through the AV bundle and down the left and right bundle branches of the Purkinje fibers. The Purkinje fibers conduct the impulse to all parts of the ventricles, causing contraction (Guyton, 1982).
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