TAILIEUCHUNG - AACN Essentials of Critical Care Nursing_2

Critical care nursing is a complex, challenging area of nursing practice, where clinical expertise is developed over time by integrating critical care knowledge, clinical skills, and caring practices. Finding a textbook that comprehensively yet succinctly presents essential information about how best to safely and competently care for critically ill patients and their families is a challenge for those charged with the education of new critical care practitioners. Most current textbooks deal with critical care content by combining essential and advanced concepts, rather than by providing the essential concepts first and introducing more advanced concepts later. In-depth discussion of these advanced concepts, although meaningful and important for advanced practitioners, often overwhelms the novice practitioner. | Advanced Concepts in Caring for the Critically III Patient Advanced ECG Concepts Eighteen Carol Jacobson Knowledge Competencies 1. Identify electrocardiogram ECG characteristics and treatment approaches for each of the following advanced arrhythmias Supraventricular tachycardias Wide QRS beats and rhythms 2. Using the 12-lead ECG determine the following Bundle branch blocks Axis of the heart Patterns of myocardial ischemia injury and infarct 3. Identify ECG characteristics of single- and dualchamber pacemakers during normal and abnormal functioning. THE 12-LEAD ELECTROCARDIOGRAM The 12-lead ECG records electrical activity as it spreads through the heart from 12 different leads which are in turn recorded by electrodes placed on the arms and legs and in specific spots on the chest. Each lead represents a different view of the heart and consists of two electrodes. A bipolar lead has two poles one positive and one negative. A unipolar lead has one positive pole and a reference pole that is a point in the center of the chest that is mathematically determined by the ECG machine. The standard 12-lead ECG consists of six frontal plane limb leads that record electrical activity traveling up down and right left in the heart and six precordial leads that record electrical activity in the horizontal plane traveling anterior posterior and right left. Limb leads are recorded by electrodes placed on the arms and legs and precordial leads are recorded by electrodes placed on the chest Figure 18-1 . A camera analogy makes the 12-lead ECG easier to understand. Each lead of the ECG represents a picture of the electrical activity in the heart taken by the camera. In any lead the positive electrode is the recording electrode or the camera lens. The negative electrode tells the camera which way to shoot its picture and determines the direction in which the positive electrode records. When the positive electrode sees electrical activity traveling toward it it records an upright .

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