A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:
A. Check the client status and lead placement.
B. Press the recorder button on the electrocardiogram console.
C. Call the physician.
D. Call a code blue.
Correct Answer: A. Check the client status and lead placement.
Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. Unlike invasive procedures, no preparation is needed, but the patient should be advised to keep the monitor away from other electrical devices while wearing the device. Physicians should recommend not to put lotion or moisturizer on the chest as it will affect the attachment of leads.
Option B: After continuous improvement and progress, the Holter is now the size of a small cell phone and gives two types of primary data to analyze. One is the QRS complex, and the other is the R-R interval. It continuously records until it is detached from the patient or it runs out of power, although it is usually used for 24-48Hrs. The power supply lasts 80-100 hours with a tape recording capacity of ten hours.
Option C: There is no need to call the physician immediately. Mobile electrocardiographic monitoring is contraindicated if it delays urgent treatment, hospitalization, or a procedure. For example, it should not be part of the initial investigation for angina, where a stress test would be more appropriate.
Option D: Calling a code blue is unnecessary. The ACC/AHA guidelines discouraged the use of ambulatory ECG for either arrhythmia detection or analysis of heart rhythm variability for risk assessment in patients without symptoms of arrhythmia, even if they had cardiovascular conditions such as left ventricular hypertrophy, or valvular heart disease.
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