EKG Worksheet for Nursing Students EKG Worksheet www.anurseinthemaking.com Kristine@anurseinthemaking.com @Kristine_nurseinthemaking @NurseInTheMaking Need more help with nursing school? @nurseinthemakingkristine @anurseinthemaking SCAN ME! www.etsy.com/shop/nurseinthemaking By purchasing this material, you agree to the following terms and conditions: you agree that this material and all other media produced by NurseInTheMaking LLC are simply guides and should not be used over and above your course material and teacher instruction in nursing school. When details contained within these guides and other media differ, you will defer to your nursing school’s faculty/staff instruction. Hospitals and universities may differ on lab values; you will defer to your hospital or nursing school’s faculty/staff instruction. These guides and other media created by NurseInTheMaking LLC are not intended to be used as medical advice or clinical practice; they are for educational use only. You also agree to not distribute or share these materials under any circumstances; they are for personal use only. © 2023 NurseInTheMaking LLC. All content is property of NurseInTheMaking LLC and www.anurseinthemaking.com. Replication and distribution of this material is prohibited by law. All digital products (PDF files, ebooks, resources, and all online content) are subject to copyright protection. Each product sold is licensed to an individual user and customers are not allowed to distribute, copy, share, or transfer the products to any other individual or entity, they are for personal use only. Fines of up to $10,000 may apply and individuals will be reported to the BRN and their school of nursing. EKG Waveform Fill out the EKG waveform: What is happening during: P-wave PR interval QRS interval T-wave Depolarization Repolarization Depolarization Repolarization Depolarization Repolarization Define: Depolarization © 2023 NurseInTheMaking LLC Repolarization EKG Waveform answer key Fill out the EKG waveform: R T P Q S PR Interval QT Interval QRS Complex What is happening during: P-wave Atrial contracting PR interval Repolarization The time between atrial depolarization & ventricular depolarization QRS interval T-wave Depolarization Ventricle contracting Ventricle relaxing Depolarization Repolarization Depolarization Repolarization Define: Depolarization DEpolarization = DEcompressing © 2023 NurseInTheMaking LLC Repolarization repolarization = • relaxing • repolarizing • refilling with blood EKGs Numbers to know: Basic Rhythms Normal sinus Tachycardia Bradycardia Heart Rhythm Measurements PR Interval ? 1 sec. QRS Complex QT Interval EKG strip boxes 1 small box = 1 large box = ? 0.04 sec. 5 large boxes = ? 0.20 sec. Place the electrodes: © 2023 NurseInTheMaking LLC EKGs answer key Numbers to know: Basic Rhythms Normal sinus 60 – 100 bpm sinus Tachycardia > 100 bpm sinus Bradycardia < 60 bpm Heart Rhythm Measurements PR Interval 0.12– 0.20 seconds QRS Complex QT Interval 1 second 1 sec. 0.06 – 0.12 seconds < 0.40 seconds EKG strip boxes 1 small box = 0.04 seconds 1 large box = 0.20 seconds 5 large boxes = 0.04 1 second 0.04 sec. seconds 0.20sec. 0.20 seconds Place the electrodes: White on right Smoke over FIRE Clouds over GRASS Chocolate in my heart © 2023 NurseInTheMaking LLC Interpret the rhythm Rhythm Interpretation © 2023 NurseInTheMaking LLC Key Factors Interpret the rhythm Rhythm Interpretation – Ventricular Tachycardia Looks like a tombstone appearance (this can be a deadly rhythm) Sinus Tachycardia Normal rhythm, just a fast rate Ventricular Fibrillation (V-fib) Small fibbing waves Atrial Fibrillation (A-fib) Irregular R-R intervals! Premature Ventricular Contraction (PVCs) PREMATURE conduction of a QRS complex Asystole Flat line Atrial Flutter (A-flutter) Sawtooth appearance between R-R intervals Sinus Brady Normal rhythm, just a slow rate Supraventricular Tachycardia (SVT) It looks like S's for Supraventricular sawtooth © 2023 NurseInTheMaking LLC Key Factors Normal Sinus Rhythm looks like tombstones PVC answer key Heart Blocks Match the heart block to the correct name: 1st degree 2nd degree (Wenckebach or Mobitz Type I) 2nd degree (Mobitz Type II) 3rd degree (Complete heart block) Match the strip to the correct electrolyte imbalance: Hypokalemia Hypocalcemia Hypercalcemia Hyperkalemia Hypomagnesemia Hypermagnesemia © 2023 NurseInTheMaking LLC Heart Blocks answer key Match the heart block to the correct name: 1st degree If the R is far from the p, than you have First degree 2nd degree (Wenckebach or Mobitz Type I) P waves get longer, longer, & DROP, its a case of WENCKEBACH 2nd degree (Mobitz Type II) If some R’s don’t get through, prepare to pace that Mobitz II 3rd degree (Complete heart block) If P’s & Q’s don't agree, than you have a Third Degree Match the strip to the correct electrolyte imbalance: © 2023 NurseInTheMaking LLC Hypokalemia hypokalemia think Low (flattened or inversion) Hypocalcemia QT prolongation Hypercalcemia Shortened ST segment Hyperkalemia hyperkalemia think high (peaked) Hypomagnesemia Tall T wave & ST depression Hypermagnesemia Prolonged PR interval & a wide QRS Nstemi vs. STEMI STEMI st segment biomarkers blockage stands for Which is which? © 2023 NurseInTheMaking LLC NSTEMI STEMI NSTEMI STEMI NSTEMI ST Elevation Myocardial Infarction Non-ST Elevation Myocardial Infarction Complete Blockage Incomplete (partial) Blockage biomarkers blockage stands for Nstemi vs. STEMI answer key st segment ST segment is ELEVATED © 2023 NurseInTheMaking LLC ST segment is NOT elevated ST depression or T inversion ekg basics Fill in the blank & True/False: 1. patient at risk for blood clots. & place the is a racing pulse which originates from above the ventricle. 2. 3. PEA stands for 4. Irregular and false readings caused by patient or lead movement is called 5. NSR stands for 6. The . . node is the primary pacemaker of the heart. 7. TRUE / FALSE Ventricular Tachycardia (VT) patients can have a pulse or no pulse. 8. TRUE / FALSE A myocardial infarction will always present with ST elevation. 9. TRUE / FALSE A bundle branch block (BBB) is not able to be detected by an EKG. 10. TRUE / FALSE An implanted pacemaker is a contraindication to performing an EKG. © 2023 NurseInTheMaking LLC . ekg basics answer key Fill in the blank & True/False: 1. Atrial Fibrillation (A-fib) patient at risk for blood clots. 2. & Both cause pooling of blood in the atria = risk for clots Supraventricular tachycardia is a racing pulse which originates from above the ventricle. 3. PEA stands for 4. Irregular and false readings caused by patient or lead movement is called 5. NSR stands for 6. The pulseless electrical activity Normal Sinus Rhythm sinoatrial node (SA node) . artifact . node is the primary pacemaker of the heart. 7. TRUE / FALSE Ventricular Tachycardia (VT) patients can have a pulse or no pulse. 8. TRUE / FALSE A myocardial infarction will always present with ST elevation. 9. TRUE / FALSE A bundle branch block (BBB) is not able to be detected by an EKG. 10. TRUE / FALSE An implanted pacemaker is a contraindication to performing an EKG. © 2023 NurseInTheMaking LLC place the Atrial Flutter . treatment Match the term with the associated key point: Atrial Fibrillation A. Can be caused by certain psychiatric medications or Sinus bradycardia B. IV amiodarone, IV lidocaine Sinus tachycardia Complete heart block Supraventricular tachycardia STEMI Prolonged QT interval PVCs Peaked T-Waves Artifact Ventricular fibrillation ondansetron C. Morphine, aspirin, oxygen, nitroglycerin & cardiac catheterization D. Appears as twisting patterns; treated with magnesium sulfate E. Rearrange and stabilize leads, encourage patient to remain as still as possible F. Assess serum K+ and troponins; seen with hyperkalemia or MI G. Recommended treatment is placement of pacemaker H. Often seen in endurance athletes at baseline I. Begin CPR & Code Blue protocol J. Caused by anxiety & stimulants; may be treated with beta blockers K. Treated with cardioversion, heparin therapy L. Carotid massage, IV adenosine, beta blockers M. Infrequent occurrence not always concerning; frequent occurrence may lead to weakened cardiac muscle Torsades de pointes N. Irregular rhythm which begins and may resolve by itself within 1 week (intermittent) Paroxysmal atrial fibrillation Recurrent ventricular tachycardia with pulse Pulseless ventricular tachycardia © 2023 NurseInTheMaking LLC O. Treat with defibrillation treatment answer key Match the term with the associated key point: Atrial Fibrillation k A. Can be caused by certain psychiatric medications or Sinus bradycardia h B. IV amiodarone, IV lidocaine Sinus tachycardia j Complete heart block g Supraventricular tachycardia l STEMI c Prolonged QT interval a PVCs m Peaked T-Waves f Artifact e Ventricular fibrillation o ondansetron C. Morphine, aspirin, oxygen, nitroglycerin & cardiac catheterization D. Appears as twisting patterns; treated with magnesium sulfate E. Rearrange and stabilize leads, encourage patient to remain as still as possible F. Assess serum K+ and troponins; seen with hyperkalemia or MI G. Recommended treatment is placement of pacemaker H. Often seen in endurance athletes at baseline I. Begin CPR & Code Blue protocol J. Caused by anxiety & stimulants; may be treated with beta blockers K. Treated with cardioversion, heparin therapy L. Carotid massage, IV adenosine, beta blockers M. Infrequent occurrence not always concerning; frequent occurrence may lead to weakened cardiac muscle Torsades de pointes d N. Irregular rhythm which begins and may resolve by itself within 1 week (intermittent) Paroxysmal atrial fibrillation n Recurrent ventricular tachycardia with pulse b Pulseless ventricular tachycardia i © 2023 NurseInTheMaking LLC O. Treat with defibrillation Dear future nurse, You may be stressed, you may feel tired, and you may want to give up. Nursing school is hard, there's no doubt about it. Everyone cries, everyone has meltdowns, and there will be moments you don't feel qualified for the task at hand. But take heart, the challenge only makes you stronger. Put in the work, show up on time, and find an amazing study group. You got this! – Kristine Tuttle, BSN, RN By purchasing and/or downloading this material, you agree to the following terms and conditions: you agree that this ebook and all other media produced by NurseInTheMaking LLC are simply guides and should not be used over and above your course material and teacher instruction in nursing school. When details contained within these guides and other media differ, you will defer to your nursing school’s faculty/ staff instruction. Hospitals and universities may differ on lab values; you will defer to your hospital or nursing school’s faculty/staff instruction. These guides and other media created by NurseInTheMaking LLC are not intended to be used as medical advice or clinical practice; they are for educational use only. You also agree to not distribute or share these materials under any circumstances; they are for personal use only. © 2023 NurseInTheMaking LLC. All content is property of NurseInTheMaking LLC and www.anurseinthemaking.com. Replication and distribution of this material is prohibited by law. All digital products (PDF files, ebooks, resources, and all online content) are subject to copyright protection. Each product sold is licensed to an individual user and customers are not allowed to distribute, copy, share, or transfer the products to any other individual or entity, they are for personal use only. Fines of up to $10,000 may apply and individuals will be reported to the BRN and their school of nursing. www.anurseinthemaking.com Electrify your studying with The Complete Nursing School Bundle ® 300+ p a filled wi ges th & MUCH EKGs More! take 10% off! Scan or click to shop! © NurseInTheMaking 2023 or use coupon code EKGTAKE10 at checkout