Bài giảng Medical Assisting - Chapter 52: Electrocardiography and Pulmonary Function Testing

ChapterPowerPoint® to accompany Second EditionRamutkowski  Booth  Pugh  Thompson  WhickerCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.Medical AssistingChapter521Objectives52-1 Describe the anatomy and physiology of the heart.52-2 Explain the conduction system of the heart.52-3 Describe the basic patterns of an electrocardiogram (ECG.)52-4 Identify the components of an electrocardiograph and what each does.52-5 Explain how to position the limb and precordial electrodes correctly.Electrocardiography and Pulmonary Function Testing 2Objectives (cont.) 52-6 Describe in detail how to obtain an ECG.52-7 Identify the various types of artifacts and potential equipment problems and how to correct them.52-8 Discuss how the ECG is interpreted.52-9 Define exercise electrocardiography.52-10 Explain the procedure of Holter monitoring.52-11 Describe the anatomy and physiology of the lung.Electrocardiography and Pulmonary Function Testing3Objectives (cont.)52-12 Describe various types of spirometers.52-13 Describe the procedures of performing spirometry.Electrocardiography and Pulmonary Function Testing4Introduction It is not uncommon for patient to have cardiovascular or respiratory problems.You may be responsible for performing, screening, and/or diagnostic testing in the physician’s office. You will learn how to correctly perform testing on the cardiac and respiratory systems.5Electrocardiography and Pulmonary Function TestingYour role will be to perform:Electrocardiography – graphic recordings of the electrical impulses of the heartPulmonary function tests – measure and evaluate a patient’s lung capacity and volume6Anatomy of the Heart Muscular pump that circulates blood throughout the bodyCarries oxygen and nutrients to tissues and removes waste productsPumping action begins in the muscle tissue of the heart (myocardium)Double pumpRight sideLeft side A description of the anatomy and physiology of the heart will help you better understand electrocardiography.7Anatomy of the Heart Right side receives blood from the body and pumps blood to the lungs where carbon dioxide is exchanged for oxygen.Oxygenated blood flows into the left side of the heart and is pumped into the aorta and to all parts of the body.8Heart Valves and VesselsUsing the on-screen pen draw a line from the label to its location.Vena CavaAortaPulmonary VeinsPulmonary ArteryTricuspid ValveBicuspid ValveAortic ValvePulmonary Valve9Physiology of the Heart Two pumps – divided into separate chambers that work as a single unit.Contraction of the atria (systole) followed by the contraction of the ventricles moves the blood.Diastole – follows systole by a relaxation phase.The sequence of systole and diastole is a complete heartbeat (cardiac cycle) and lasts about 0.8 second.10Conduction System of the Heart Cardiac cycle is controlled by specialized tissues in the heart wall that transmit electrical impulses.These impulses cause the heart to contract.Sinoatrial (SA) node pacemaker of the heart – right atrium.Atrioventricular (AV) node – bottom of right atrium.Bundle of HisPurkinje fibers11Conduction SystemBundle BranchesBundle of HisSA NodePurkinje FibersAV NodeUsing the on-screen pen draw a line from the label to its location.12Conduction and ElectrocardiographyTransmission, magnitude, and duration of the various electrical impulses of the heartElectrocardiograph – machine that measures and displays impulses of the heart13Basic Pattern of the ElectrocardiogramPeaks and valleys called waves are labeled P, Q,R,S,T,U. Each letter represents part of the pattern.Basic Pattern of ECG14Types of ElectrocardiographsStandard machine – 12 lead that records 12 different views at onceSingle channel – one lead and records only one view15Lead PlacementLimb leads – six leads, three are standard, three are augmented leadsBipolar leads monitor two limbsAugmented leads monitor one limb and a point midway between two other limbs (unipolor)16Lead Placement Precordial leads – six leads (unipolar)Placed across the chest Precordial Leads Placement17Obtaining an ECG Prepare the room and equipmentQuiet, protected from interruptionsAll other electrical equipments offSturdy and comfortable exam tableEnsure equipment is working properly18Obtaining an ECG (cont.)Preparing the patientIntroduce yourselfExplain the procedureAnswer any questionsComplete ECG procedure accurately19TroubleshootingYou must recognize artifacts and identify sources of interferences.Caused by improper techniques, poor conduction, outside interference, or improper handling. 20Troubleshooting (cont.)Wandering baseline-causes somatic interference or mechanical problemFlat line – loose or disconnected wireExtraneous marks – careless handling21Interpreting the ECG You will not be responsible for interpreting an ECGSometimes knowing how they are interpreted will allow you to recognize a problem that requires immediate attention.Heart rhythmHeart rateIntervals and segmentsWave changes22Exercise ElectrocardiographyStress tests - assesses the heart’s conduction system during exercise when the demand for oxygen increases.Measures the patient’s responses to workload.23Holter Monitoring Electrocardiography device that includes a small cassette recorder worn around a patient’s waist or shoulder strap to record the heart’s electrical activity.Patient is to do normal daily activities and keep a written log of activities and of stress or symptoms experienced.24Apply Your KnowledgeWhere is the atrioventricular node located?25Apply Your Knowledge -AnswerThe atrioventricular (AV) node is located at the bottom of right atriumWhere is the atrioventricular node located?26Anatomy of the Respiratory SystemComposed of nose, pharynx, larynx, trachea, two bronchi, and the lungsThe alveoli is where exchange of gases between the air and the blood (external respiration) occurs27Physiology of the Respiratory SystemExternal respiration :Ventilation – movement of air in and out of the lungsDiffusion:Passive process wherein oxygen and carbon dioxide cross the capillary and alveolar membranes and enters the capillaries or alveoli28Physiology of the Respiratory System (cont.)Perfusion (internal respiratory) – Exchange of oxygen in the blood for carbon dioxide in the cells of the body tissue and organsPerfusion, diffusion, and ventilation occur simultaneously29Pulmonary Function TestingEvaluates lung volume and capacity.Used to evaluate shortness of breath. Help detect and classify pulmonary disorders.AsthmaCystic fibrosisCOPD 30SpirometrySpirometer – Measures air taken in by and expelled by the lungs.Forced vital capacity (FVC) – greatest volume of air that can be expelled when a person performs rapid, forced expiration.Types of spirometers:Computerized Mechanical31Performing SpirometryPatient preparation:Inform the patient about conditions that could affect the test accuracy.Explain that he/she will wear a nose clip.Be sure patient forms a tight seal around the mouthpiece with his/her lips.Position the patient – chin slightly elevated and neck slightly extended.32Performing Spirometry (cont.)Performing the maneuver:Urge patient to blow hard and to continue blowing until you tell them to stop.Obtain three acceptable maneuvers. Observe the patient for signs of breathing difficulty. Notify physician immediately if symptoms occur.33Apply Your KnowledgeWhat does FVC abbreviate?34Apply Your Knowledge -Answer Forced vital capacity (FVC) – greatest volume of air that can be expelled when a person performs rapid, forced expiration.What does FVC abbreviate?35Summary Medical Assistant Electrocardiography and pulmonary function testing play a vital role in diagnosis and treatment of cardiac and pulmonary disease. You need to know the basics of the conduction system of the heart, components of the ECG, and the correct techniques to get a spirometry reading.36End of ChapterEnd of Chapter37