Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach

344

Copyright © 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Skill Checklists for Taylor's Clinical Nursing Skills:

SKILL 16-2

Applying a Cardiac Monitor (Continued)

Comments

11. Expose the patient’s chest and determine electrode positions,
    based on which system and leads are being used. If necessary,
    clip the hair from an area about 10 cm in diameter around
    each electrode site. Clean the area with soap and water and
    dry it completely to remove skin secretions that may interfere
    with electrode function.


12. Remove the backing from the pregelled electrode. Check
    the gel for moistness. If the gel is dry, discard it and
    replace it with a fresh electrode. Apply the electrode to the
    site and press firmly to ensure a tight seal.Repeat with
    the remaining electrodes to complete the three-lead or five-
    lead system.


13. When all the electrodes are in place, connect the appropri-
    ate lead wire to each electrode. Check waveform for clarity,
    position, and size. To verify that the monitor is detecting
    each beat, compare the digital heart rate display with an
    auscultated count of the patient’s heart rate.If necessary,
    use the gain control to adjust the size of the rhythm tracing,
    and use the position control to adjust the waveform
    position on the monitor.


14. Set the upper and lower limits of the heart rate alarm,
    based on the patient’s condition or unit policy.


15. For telemetry, place the transmitter in the pouch in the hos-
    pital gown. If not available in gown, use a portable pouch.
    Tie the pouch strings around the patient’s neck and waist,
    making sure that the pouch fits snugly without causing dis-
    comfort. If no pouch is available, place the transmitter in
    the patient’s bathrobe pocket.


16. To obtain a rhythm strip, press the RECORD key either at
    the bedside for monitoring or at the central station for
    telemetry. Label the strip with the patient’s name and room
    number, date, time, and rhythm identification. Analyze the
    strip, as appropriate. Place the rhythm strip in the
    appropriate location in the patient’s chart.


17. Return the patient to a comfortable position. Lower
    bed height and adjust the head of bed to a comfortable
    position.


18. Remove additional PPE, if used. Perform hand hygiene.

ExcellentSatisfactoryNeeds Practice