A patient in operation theatre. Anesthetist instructs to place ECG monitoring and a 3 lead ECG available. Wha… - AIIMS Rishikesh & Jodhpur NO - 2017

AIIMS Rishikesh & Jodhpur NO - 2017

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

In an operating theatre, a 3-lead ECG is a standard tool for continuous cardiac monitoring during anesthesia.
Lead II is the most commonly used lead for this purpose because its electrical axis aligns closely with the heart's natural conduction pathway.
This alignment provides the clearest and most prominent P waves and QRS complexes, which is essential for accurately monitoring heart rate and detecting any cardiac arrhythmias that may occur during surgery.
Therefore, selecting Lead II for observation is the correct and standard nursing action in this scenario.

Option B: Canceling the operation is an extreme and unnecessary action. A 3-lead ECG provides adequate monitoring for a routine surgical procedure.
Option C: A 12-lead ECG is a diagnostic tool, not the standard for continuous intraoperative monitoring. It is cumbersome and provides more information than is needed for routine rhythm surveillance.
Option D: Shifting the patient back to the ward is illogical. The patient is prepared for surgery, and the available monitoring (3-lead ECG) is appropriate for the procedure.

Clinical Relevance

Nursing practice connection: Use the key finding related to Intraoperative ECG Monitoring to guide bedside assessment, documentation, and the next nursing action.
A nurse's understanding of basic ECG monitoring is crucial for patient safety in the perioperative setting. Correct lead placement and selection ensure accurate data for the anesthesia team.
Recognizing that Lead II is standard for rhythm monitoring allows the nurse to act efficiently and correctly without causing unnecessary delays or alarms.
What if? If the patient had a known history of an old inferior wall myocardial infarction, the anesthetist might request monitoring V5 in addition to or instead of Lead II to better watch for signs of anterior or lateral ischemia. This demonstrates the need to tailor monitoring to the patient's specific history.

How to Approach the Question

First, identify the clinical setting: an operation theatre.
Next, note the available equipment and the task: using a 3-lead ECG for patient monitoring as instructed.
Recall the standard procedures for intraoperative monitoring. A 3-lead ECG is standard for rhythm monitoring.
Evaluate the options based on standard practice. Ask yourself, 'What is the most common and appropriate lead for rhythm monitoring with a 3-lead system?'
Eliminate options that are extreme (cancel surgery, shift patient) or inappropriate for the specific type of monitoring required (a 12-lead ECG is for diagnosis, not continuous rhythm monitoring).
Select the option that represents the standard, correct procedure, which is observing Lead II.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e pp. 469-471, 468-470

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 189-191