Question

Case Study

Eliot Masterson, a 41-year-old business owner, was seen by Dr. Salpega for a routine physical. During the office visit, Eliot informed Dr. Salpega that he has had some episodes of chest pain over the past few months that have occurred after exercising. Dr. Salpega decides to have his medical assistant, David Dolan, perform an ECG on Mr. Masterson.

1. When the physician is finished examining Mr. Masterson, he asks the medical assistant to set up the patient for Holter monitoring. How would you explain to the patient the purpose of the Holter monitor test? Be specific providing an actual response that you would give the patient.

2. It is important to provide the patient with a full understanding of the purpose of the diary that is used during the Holter monitoring test. How would you explain the use of the diary and what specific information the patient should include in it?

3. After the patient has the Holter monitor applied and is ready to leave the office, he tells the medical assistant the he will just go home and rest until the test is over. How should the medical assistant respond to this comment? Is it alright for the patient to go home and rest for the duration of the test?

Answer 1

INTRODUCTION

Holter monitoring is also known as AMBULATORY ELECTROCARDIOGRAPHY.Norman Jefferis was an American biophysicist who invented the holter monitoring and it is a portable devices for continously monitoring the electrical activity of the heart for 24 hours or more.

MEANING

-It is a small wearable device that keeps record of your rhythm of the heart

-A Holter monitor is a small battery powered medical device that measure your heart electrical activities such as rate and rhythm

HOW ITS WORKS

1 - Electrodes are placed on the chest area with the leads attatched to a small recorder

2-These electrodes will pick up the signals from the heart and transfer them to the portable recorder

3-The recording will later analyzed and printed

4-Interpretation of the report by the physician

QUESTION-1

The main purposes of this monotoring tests are follows;

-The Holter monitor may be used to detect irregularities in your heart rhythm that an electrocardiogram could not detect

-It is important to diagnose the nature of arrythmia

-Help for the detection of heart rhythm disturbances and the most often disturbances are syncope,unexplained lightheadedness and palpitations

-Can also be used to look for episides of cardiac ischemia

- Can detect an episodes of possible ischemia and average heart rates

-Can detect the strong signs of ischemia

-Detect the heart functions

   -Continous recording of your heart rate and rhythm for 24 hours to 72 hours

-Used to detect for other abnormalities that may affect the normal heart functions

  -Monitor wheather your heart is getting enough oxygen or not

  -Evaluation of therapeutic interventions like medications

-Evaluation of pacemaker

   -Detection of myocardial ischemia

-Research puroses like coronary rehabilitation and surgical evaluations

- Hoter monotoring can be used to evaluate the effectivness of a patients cardiac medicatios..

The cardiac classess of medications that are commonly evaluated are;

-CLASS -1 (anti-arrhythmic drugs)

-CLASS-2 (beta blockers)

   -CLASS-3 (drives blocked potassium)

   -CLASS-4 (calcium channel blockers)

-CLASS-5 (vago tonic anti-arrhythmic drugs)

QUESTION-2

- The purposes of the diary that used during the holter monitoring tests

-The importance are listed below;

-The patient is asked to keep a diary of all symptoms,activities and events during the period of Holter monitoring

-Help to diagnosing the complaints

-Patient should record symptoms such as palpitations,dyspnoea,fatigue,dizziness,chest discomfort,nausea and vomiting,syncope etc

-Patient should be recorded any discomfort not only chest pain

- Patient should be recorded pain in the chest,arms,jaw,sharp pain and indigestion

-Patient should be instructed to grade the symptoms such as severe,moderate aor mild

-It is also important to note the following things during this tests such as;

-Meals

-Taking of any stimulants such as coffee,chocolates,smoking

Taking medications

-Stress such as anger,frustrations,sorrow,depression,confusion,anxiety etc

-Exercise or any othe rphysical activity and sexual activity

-Bowel movement,heavy lifting,and hyperventilation

   -Patient should note significat activities you may experience

  -Write in the time of day for each entry you make

-Note any symptoms you have

  -Write down any abnormal sensations you may experience

QUESTION-3

Yes patient can take rest at home,but they have to follow some guidlines as follows;

-Do not take bath ,shower,or swim while wearing it

-Do not switch off the monitor without doctor ordrer

-Do not remove the tape or battery from inside the monitor

Do not try to remove the memory from the monitor

-Stay away from electric blankets,metal detectors,and high votlage areas such as power lines

- Follow the instructions

CONCLUSION

During this procedure they have follow the principles or guidlines.Before  the procedure the cardiologist have to assess the TIMING,LOCATION,WHAT TO WEAR,OTHER PREPARATIONS and COST AND HEALTH INSURENCE.During the procedure assess for the conditions and after the procedure have to interpret the results

NURSING DIAGNOSIS

-impaired heart rhytm

-impaired tissue perfusion

-activity intolerance

-risk for complications