Medical Surgical EKG #8

Question

The nurse evaluates the following electrocardiogram strip following a cardiac intervention and determines that:

Answers

  1. Treatment for the myocardial infarction is unsuccessful
    • Rationale:

      This answer is not correct because a myocardial infarction is not treated with a pacemaker. Indications for this pacemaker include symptomatic second or third degree heart block, syncope with sinus node disease, or persistent AV block post surgery.

  2. Atrial-sensed pacing spikes are present following pacemaker insertion
    • Rationale:

      This answer is correct because an ECG depicting spikes followed by a QRS complex indicates a paced rhythm so the client has just received a new pacemaker. A spike before the P indicates it is atrial-sensed pacing.

  3. Atropine administration was successful
    • Rationale:

      This answer is not correct because atropine does not cause spikes followed by a QRS complex. Atropine is used to treat bradycardia to increase the client’s heart rate.

  4. Blockage of the left arterial descending coronary artery
    • Rationale:

      This answer is not correct because blockage of the left arterial descending coronary artery will not cause spikes followed by a QRS complex on an ECG. A pacemaker causes spikes on an ECG.

Overview

An ECG depicting spikes followed by a QRS complex indicates a paced rhythm. The client has had a pacemaker insertion.

Explanation

Learning Outcomes

An ECG depicting spikes followed by a QRS complex indicates a paced rhythm so the client has just received a new pacemaker. Spikes or lines on an ECG indicate the pacemaker is firing and electrical impulse. A spike before the P indicates it is atrial-sensed pacing. Indications for this pacemaker include symptomatic second or third degree heart block, syncope with sinus node disease, or persistent AV block post surgery. Pacemakers, themselves, do not generally hurt as they are working. Immediately after the procedure to place a pacemaker the chest can be sore where the surgeon made the incision to place the pacemaker. There can be some bruisin and slight swelling at the sight but this only lasts for a couple weeks maximum. The client may be able to feel the hard ridge of the pacemaker.

Test Taking Tip

Remember that the spike or line on an ECG indicates artificial electrical activity in the heart caused by a pacemaker. This firing of the pacemaker is sending an electrical impulse to cause the heart to beat normal to allow adequate perfusion.

Video Rationale