Please help to read an EKG for care plan

[bjb12]

I have a patient presenting with pulmonary edema. My instructor wants me to develop a cardiac care plan that has to do with how pulmonary edema. I have EKG results and I don't know how to read them.

7/2/10

HR 104

PR Interval 154

P Wave Frontal axis 35

QRS duration 78

QRS Complex Frontal axis -1

QT Interval 326

QT Interval Corrected 404

T Wave Frontal Axis - 1

7/3/10

HR 89

PR Interval (ms) 146

P Wave Frontal axis (deg) 47

QRS duration (ms) 88

QRS Complex frontal axis (deg) -1

QT Interval (as) 342

Qt interval corrected 393

T Wave Frontal axis -1

These numbers seem high and I don't know what kind of lead they were using... and I have no clue how to interpret them and I understand that hypoxia can lead to arrythmias. This pt has a hx of paroxamal supraventricular arrythmias although during her hospital stay she didn't have an extremely elevated HR. She has hx of SLE, DVT, GERD... but her hospital dx was atypical pneumonia, pulmonary edema, dyspnea, and hypoxemia. Her Pulse ox was 94% even on O2.

Any help is appreciated.

[skelley53]

I empathsize with your dilema. Start by comparing "normal" ecg measurements with what you have been given. There are decimal points missing for your numbers, so you might want to add those to your question. (For intance, normal PR interval > .20 would indicate a heart block.) I had just such a patient Sat evening. Her pulmonary edema was 2nd to her CHF, significant murmur, leading to crackles through out all fields, peripheral edema. She was recieving IVF at 100 cc/hr for 12 hours due to dehydration from 7 days of diarrhea. However, she only weighed 103#! Once I decreased her fluids, gave 20 mgm furosemide, her HR came down, saturation went up, and crackles were decreasing.....if you provide decimals for numbers, I can be of more help.

[pawashrn]

1: don't interpret the ekg, that is for the cardiologist. Remember your a nurse think symptoms and signs that you recognize to assist in the patient's treatment.

Ok. SVT causes decrease fluid circulation, causing fluid to backup into the lungs, Hence Pulm edema-Plan Fluid overload, calculate iv and po intake compare to urine and loose stool output. 2)SVT can be caused by stress, Plan: relaxation and calm enviroment, 3) Digoxin/ cardizem for symptomatic svt Plan: compliance w/ medications( taking pulse) 4)family coping- coming out of svt patients run the risk of throwing micro-clots teach family about identifying strokes. helpful?

[bjb12]

Thank you very much for the info. I turned the care plan in, but I will probably be getting it back with things to "fix." So I'll be able to add this information to it. :)