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EKG Monitor Technician

COURSE DESCRIPTION: This course is designed to train students to set up and run a 12 lead EKG and attach a Holter monitor. Instruction is provided in the anatomy and physiology of the heart and terminology common to the cardiovascular system. Interpretation of EKGs includes heart rate, basic rhythm strips, and the identification of rhythm abnormalities. Students are trained to recognize changes in EKGs, heart blocks, hypertrophy, infarction, and emergency situations and that require immediate action. Hands-on training is an integral part of this training. English language arts and math are reinforced throughout the course. Medical Terminology is a required pre-requisite. COURSE INFORMATION: Prerequisite: Medical Terminology Dress Requirement and Grooming: Industry standard Course Length: 90 hours Curriculum Outline Revision Date: 06/06

STATE AND FEDERAL DESIGNATIONS System

California Basic Educational Data System Code (CBEDS) California Department of Education (CDE) Industry Sector

Designation

4265-Diagnostic Services F-6 Health Services 29-2031.00 EKG Technician

CAREER TECHNICAL EDUCATION INDUSTRY SECTOR:

· Health Science & Medical Technology

US Department of Education (USDOE) Career Cluster US Department of Labor Dictionary of Occupational Titles (DOT)

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INFORMATION ABOUT COMPETENCY-BASED COURSES A course description states the scope and content of a course. Competency is a skill attainment. Competency is the minimum level of skill a student has to demonstrate to achieve success. Competency-based instruction measures student success by demonstration of competency and program seat time. Competency-based instruction targets academic and career technical education to better prepare the individual for transition to either employment and/or higher education. CALIFORNIA CTE FOUNDATION STANDARDS The Foundation Standards include general competencies that all students need to master to be successful in the workplace in addition to the competencies listed in the curriculum specific to the occupational area. The Foundation Standards are similar to the competencies identified in the U.S. Department of Labor, Secretary's Commission on Achieving Necessary Skills (SCANS) Report. Subcomponents (not listed here) provide further detail about each Foundation Standard. The complete document California Career Technical Education Model Curriculum Standards, Grades Seven Through Twelve, is available at www.cde.gov. 1.0 Academics Students understand the academic content required for entry into postsecondary education and employment in the Health Science and Medical Technology sector. Communications Students understand the principles of effective oral, written, and multimedia communication in a variety of formats and contexts. Career Planning and Management Students understand how to make effective decisions, use career information, and manage personal career plans. Technology Students know how to use contemporary and emerging technological resources in diverse and changing personal, community, and workplace environments. Problem Solving and Critical Thinking Students understand how to create alternative solutions by using critical and creative thinking skills, such as logical reasoning, analytical thinking, and problem-solving techniques. Health and Safety Students understand health and safety policies, procedures, regulations, and practices, including the use of equipment and handling of hazardous materials. Responsibility and Flexibility Students know the behaviors associated with the demonstration of responsibility and flexibility in personal, workplace, and community settings. Ethics and Legal Responsibilities

Students understand professional, ethical, and legal behavior consistent with applicable laws, regulations, and organizational norms.

2.0 3.0 4.0

5.0

6.0

7.0

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9.0

Leadership and Teamwork Students understand effective leadership styles, key concepts of group dynamics, team and individual decision-making, the benefits of workforce diversity, and conflict resolution. 10.0 Technical Knowledge and Skills Students understand the essential knowledge and skills common to all pathways in the Health Science and Medical Technology sector. 11.0 Demonstration and Application Students demonstrate and apply the concepts contained in the foundation and pathway standards.

STUDENT LEARNING GOALS In order to function as productive, involved members of society, San Bernardino County ROP students will: 4. Demonstrate problem solving and critical thinking skills a. Use critical thinking skills to make informed decisions and solve problems b. Apply appropriate problem solving strategies and critical thinking skills to work-related issues and tasks 5. Demonstrate the use of appropriate technology used in the 21st Century a. Identify, analyze and integrate past, present and future technological resources for application in personal, workplace and community environments b. Utilize technological skills to enhance personal and career development

1. Demonstrate personal skills that promote success and growth in the workplace a. Know the policies, procedures, and regulations regarding health and safety b. Understand the importance of responsibility and accountability c. Understand the role of ethical behavior d. Understand how to work as a member of a team as well as independently 2. Demonstrate career planning that leads to postsecondary education and/or employment a. Know the specific requirements in a career pathway for postsecondary education, certification, and/or licensure b. Apply effective strategies for self-promotion in the hiring process 3. Demonstrate appropriate application of academic skills and concepts necessary for entry into postsecondary education and/or employment a. Apply the principles of effective oral, written, and multimedia communication in a variety of formats and contexts b. Perform mathematical computations required for industryspecific applications

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MAJOR INSTRUCTIONAL UNITS I. Introduction to EKG Monitor Technician Unit Objective: Discuss the objectives for the course, including student and teacher expectations, attendance requirements, policies and procedures, and career opportunities. Unit Competencies: A. Review the objectives, competencies, and syllabus for the course. B. Discuss instructor and student expectations, such as behavior, class rules, appropriate dress, pre-course knowledge, student evaluation and grading policies. C. Explain enrollment and attendance requirements and procedures. D. Discuss the "next steps" in the course sequence related to additional education, training, and employment. E. Review emergency, safety, and disaster procedures. F. Discuss ROP Student Learning Goals (SLGs) and the relationship of the SLGs to the course and employability. II. Anatomy and Physiology Unit Objective: Identify and name the anatomical structures of the heart and its electrical conduction system. Unit Competencies: A. Identify and define the anatomy of the heart, including valves, chambers, tissue layers, and coronary arteries. B. Diagram circulation through the heart, naming internal structures and major arteries that

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

CL Hours 2

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment Review course syllabus, grading standards, attendance, and community classroom requirements. Discuss student and teacher expectations and how they relate to the ESLRs (Expected Student Learning Results). Relate the ESLRs to industry standards for the Medical Assistant. Class discussion/participation

10

LA grades 9/10 Reading 1.0, 2.0 Writing 1.0, 2.0

Summarize text by generating relevant questions. Teacher review. Write a one-page essay that describes the function of the cardiovascular system. Writing rubric. Teacher evaluation.

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MAJOR INSTRUCTIONAL UNITS connect to the heart. Describe and illustrate the conduction system of the heart and the three states in which a myocardial cell can exist, i.e. polarized state, depolarized state, and re-polarized state. Define and explain the function of the electro conduction system, including S A Nodes, A V Nodes, Bundle of HIS, Right/Left Bundle Branches, and Purkinje fibers. Review the overall physiology of the heart and how electrical stimulation relates to the cardiac cycle. Diagram directional blood flow through the heart (from superior/inferior vena cava, right atrium, right ventricle, pulmonary artery, pulmonary veins, left atrium, left ventricle and aorta). Define hypertension, including its frequency, signs and symptoms, and subdivisions. Define Systole and Diastole and its relationship to the cardiac cycle. Describe heart sounds, S1, S2, as they relate to the cardiac cycle. Explain the function of the Vascular System, including arteries, arterioles, capillaries, venules, and veins. Explain the anatomy and physiology of the red blood cells, white blood cells, platelets, and blood plasma. Diagram the anatomy of the Autonomic Nervous System: Subdivisions · Sympathetic

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

C.

D.

E.

F.

G. H. I. J.

K.

L.

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

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MAJOR INSTRUCTIONAL UNITS · Para-sympathetic M. Describe how the Autonomic Nervous System influences heart rate, heart rhythm, blood vessel size, blood flow, and blood pressure, including, SA node pacing, rate of conduction, force of contraction and irritability of foci. III. The Electrocardiogram Unit Objective: Describe the purpose, function, and importance of the electrocardiogram (EKG). Unit Competencies: A. Discuss the history of the electrocardiogram. B. Review common medical terminology associated with an EKG. C. Define and describe the physiology of P waves, QRS complex, ST Segment, T waves, and U waves. D. Describe the P-R interval. Q-T interval, QRS complex, and ST segment. E. Define and describe atrial depolarization. F. Define and describe ventricular depolarization, and ventricular re-polarization, including the two subdivisions of ventricular re-polarization, i.e. plateau phase and rapid phase. G. Review rate calculations, amplitude, and voltage. H. List and describe the placement of limb leads, chest leads, patient position, patient preparation, and elimination of artifact. I. IV. EKG Interpretation ­ Rate Unit Objective: Demonstrate the ability to interpret basic heart rate, i.e. bradycardia, normal,

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

10

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

5

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

Page 6

MAJOR INSTRUCTIONAL UNITS and tachycardia. Unit Competencies: A. Define the following terms and their relationship to heart rate: · SA Node (Sinus Node) · Automaticity Foci · Atrial Foci · Junctional Foci · Ventricular Foci B. Define and calculate cardiac rates as they relate to normal sinus rhythm. C. Define and calculate rates as they relate to bradycardia. D. Define and calculate rates as they relate to tachycardia. V. EKG Interpretation ­ Rhythm Unit Objective: Interpret basic rhythm strips and identify rhythm abnormalities within the strips. Unit Competencies: A. Discuss sinus rhythm and sinus arrhythmia. B. Describe, illustrate, and define normal sinus rhythm and sinus arrhythmia. C. Describe, illustrate, and define Wandering Pacemaker, Multi-Focal Arterial Tachycardia, and Atrial Fibrillation. D. Describe, illustrate, and define escape rhythms and escape beats related to atrial, junctional, and ventricular foci. E. Describe, illustrate, and define premature beats related to atrial, junctional, and ventricular foci. F. Describe, illustrate, and define atrial bigeminy,

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

6

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

Page 7

MAJOR INSTRUCTIONAL UNITS trigeminy, and quadrigeminy, junctional bigeminy, trigeminy, and quadrigeminy, and ventricular bigeminy, trigeminy, and quadrigeminy. G. Describe, illustrate, and define Ventricular Parasystole. H. Describe, illustrate, and define Paroxysmal atrial, junctional, and ventricular Tachycardia. I. Describe, illustrate, and define Torsades de Pointes. J. Describe, illustrate, and define atrial flutter and ventricular flutter. K. Describe, illustrate, and define atrial fibrillation and ventricular fibrillation. L. Describe, illustrate, and define Sick Sinus Syndrome. M. Describe, illustrate, and define WolffParkinson-White Syndrome. N. Describe the pathophysiology related to Cardiac Standstill, Asystole, and Pulseless Electrical Activity (PEA). VI. Heart Blocks Unit Objective: Define the term heart blocks, and describe the EKG indicators used to identify a block. Unit Competencies: A. Describe, illustrate, and define EKG indicators used to identify a Sinus Exit Block/Sinus Block. B. Describe, illustrate and define 1st degree AV Block, 2nd degree AV Block ­ type one and 2nd degree AV Block type two, and 3rd Degree AV

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

5

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

Page 8

MAJOR INSTRUCTIONAL UNITS Block. Describe, illustrate, and define right and left Bundle Branch Block. Describe, illustrate, and define Hemiblock.

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

C. D.

VII. Axis Unit Objective: Define, illustrate, and describe axis as it relates to cardiac physiology. Unit Competencies: A. Describe how to locate axis and main QRS vector. B. Describe and illustrate axis and main QRS vector in normal quadrant. C. Describe axis and main QRS vector when the heart is in right axis deviation. D. Describe axis and main QRS vector when the heart is in extreme right axis deviation. E. Describe axis and main QRS vector when the heart is in a left axis deviation. F. Describe and illustrate how to locate main QRS vector in "degrees axis." VIII. Hypertrophy Unit Objective: Explain the term hypertrophy as it applies to the pathophysiology of the heart. Unit Competencies: A. Describe the EKG indicators used to identify right atrial hypertrophy and left atrial hypertrophy. B. Describe the EKG indicators used to identify right ventricular hypertrophy, and left ventricular hypertrophy.

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

5

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

5

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

Page 9

MAJOR INSTRUCTIONAL UNITS IX. Infarction Unit Objective: Define ischemia, injury, and infarction as they relate to the pathophysiology of the heart, and identify EKG indicators used to represent each of the above. Unit Competencies: A. Define and illustrate ischemia as it relates to the pathophysiology of the heart. B. Define and illustrate injury as it relates to the pathophysiology of the heart. C. Define and illustrate infarction as it relates to the pathophysiology of the heart. X. Miscellaneous Unit Objective: Describe EKG indicators and changes impacted by electrolyte imbalance, cardiac drug toxicity, artificial pacemakers, and heart transplants. Unit Competencies: A. Describe and illustrate EKG indicators for hyperkalemia and hypokalemia. B. Describe and illustrate EKG indicators for hypercalcemia and hypocalcemia. C. Describe and illustrate EKG indicators for digitalis toxicity and quinidine toxicity. D. Describe and illustrate EKG indicators for Pacemakers, i.e. atrial pacing, P wave triggered pacing, and A-V sequential pacing. E. Describe and illustrate EKG indicators for heart transplants.

CL Hours 5

CC Hours

CA Academic Content Standards LA grades 9/10 Reading 1.0, 2.0

HSEE

Activity/Assessment Summarize text by generating relevant questions. Teacher review.

5

LA grades 9/10 Reading 1.0, 2.0

Summarize text by generating relevant questions. Teacher review.

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

Page 10

MAJOR INSTRUCTIONAL UNITS XI. Emergency Staff Notification Unit Objective: Identify common emergency situations related to cardiac patients and the appropriate action to be taken. Unit Competencies: A. List, describe, and prioritize the immediate emergency response to ventricular fibrillation, pulseless ventricular tachycardia, ventricular standstill, and flat line. B. State the emergency action required for each of the above dysrhythmia. XII. EKG Administration Unit Objective: Demonstrate the procedure to set up and run a 12 lead EKG and attach a Holter monitor. Unit Competencies: A. Demonstrate and explain the procedures to set up and run a 12 lead EKG. B. Demonstrate patient positioning prior to administering the EKG. C. Demonstrate and explain the procedure for skin preparation, electrode placement, cable positioning, and attachment. D. Demonstrate the procedure for running the EKG strip. E. Identify EKG indicators for limb lead reversal. F. Discuss the importance of artifact recognition, i.e. somatic tremor, wandering pacemaker, and A.C. artifact. G. Demonstrate the procedure to attach a Holter monitor to a patient and provide the patient with adequate instructions regarding

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

CL Hours 5

CC Hours

CA Academic Content Standards LA grades 9/10 Writing 1.0, 2.0

HSEE

Activity/Assessment Summarize text by generating relevant questions. Teacher review. Write an essay that describes the process for responding to ventricular fibrillation. Writing rubric. Teacher evaluation.

10

LA grades 9/10 Writing 1.0, 2.0

Write an essay that describes the procedure for attaching a Holter Monitor and giving patient instruction about the monitoring process. Writing rubric. Teacher evaluation.

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MAJOR INSTRUCTIONAL UNITS documentation and unit exposure related to the activities of daily living. XIII. Legal and Ethical Issues Unit Objective: List and define basic legal and ethical requirements of an EKG Monitor Technician. Unit Competencies: A. List and discuss the legal and ethical responsibilities of the EKG monitor technician, related to patient consent and patient confidentiality. B. Describe professional conduct as it relates to patients, staff, and auxiliary services. C. Define the four "Ds" of negligence, i.e. duty, derelict, direct cause, and damages. D. Define omission, commission, defamation, assault, battery, false imprisonment, and tort. E. Define the two divisions of law, i.e. public law and private law and list several examples of each. F. Explain how individual responsibility for choice of action and behavior within legal and professional boundaries impacts quality of care (scope of practice). G. Explain the impact of patient confidentiality and HIPAA regulations on the EKG monitor technician.

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

3

LA grades 9/10 Writing 1.0, 2.0

Write an essay about one of the following: legal liability for negligence or failure to maintain confidentiality of patient information. Writing rubric. Teacher evaluation. Class discussion.

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

Page 12

MAJOR INSTRUCTIONAL UNITS XIV. Clinical Observation Unit Objective: Participate in observation and field practice in an intensive care (ICU) or coronary care (CCU) unit or in telemetry. Unit Competencies: A. Observe the procedures for obtaining and monitoring EKG readings in ICU, CCU, or telemetry. B. Describe the procedures used for obtaining and monitoring EKG readings. XV. Job Search Skills Unit Objective: List and describe the essential modalities necessary for application and employment within a health care facility. Unit Competencies: A. Identify sources of job information, including electronic sources. B. Describe various networking activities that would lead to successful employment. C. Review health care organizational policies regarding drug screening and background checks. D. Identify acceptable and unacceptable standards, i.e. attendance policies and punctuality within the work place. E. Describe employer expectations. F. Complete an application for employment using a "master application." G. Prepare a resume and letter of application. H. Participate in an in-depth mock interview demonstrating appropriate dress, behavior, and responses to interview questions.

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

CL Hours 12

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment

2

LA grades 9/10 Writing 1.0, 2.0

Write job applications and resumes that provide clear and purposeful information and address the intended audience appropriately. Modify the tone to fit the purpose and audience. Teacher review. Peer evaluations. Apply appropriate interviewing techniques: Prepare and ask relevant questions; make notes of responses; use language that conveys maturity, sensitivity, and respect; respond correctly and effectively to questions. Peer Evaluations. Create a professional portfolio including samples of class work, cover letter, resume, letter of application, letter of introduction, and letter recommendation.

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MAJOR INSTRUCTIONAL UNITS I. J. Compose appropriate thank you letters. Identify common worksite problems or issues and discuss possible solutions. Rapid Interpretation of EKGs Dale Dubin, MD

CL Hours

CC Hours

CA Academic Content Standards

HSEE

Activity/Assessment Teacher review and evaluation.

Text:

CL = Classroom and Lab CC = Community Classroom (worksite learning) LA = Language Arts Standards MA = Math Standards SC = Science Standards AC = Art Cornerstones HSEE = High School Exit Exam Standards

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