Holter monitor

It records the electrical activity of the heart for 24 hours or longer as the patient is doing his routine. It is not an invasive procedure. It does not need signed consent. We simply use it because the ECG when the patient comes in, the ECG may or may not pick up the problem.

EKG is a very good tool because it records the electrical activity of the heart. The downside of it unless the problems occur like right now it will not get it or capture it. Halter Monitor also use to evaluate whether the medication like anti-arrythmic drugs is working or not. We also put the patient on H.M. who just recovered form MI to know if the medication is working.

Holter Monitor is benign, with patches like EKG, a machine like the size of a tape recorder. Nurses must tell the patient that it is important that is she/he will not take a shower while she has the H.M on. It is very important also that she will have a log or a little book. In this book she has to log down everything that she does while she has H.M. on. Like for example:
6 am – woke up, 6:30am – took a dump
6:35 am brush my teeth

You need to explain to the patient why is using H.M. Explain what the uses are and tell her not to use electrical blanket while on H.M. Rationale: it will look like the patient has a huge defib for 8 hours.

If patient sees the light comes on in the monitor/ machine or tape recorder what she needs to do is just push each electrodes right in the center because it just means something is loose.

We can detect also the causes sometimes. Let’s say she documents 6:45am taking a dump and you see 6:45am there’s a slowing of the heart, guess what she was doing?... Valsalva manuever. Bowel straining. What happen when you really strain? You are doing valsalva manuever and it slows the heart down.

Remember the vagus nerve. It slows the heart. 7am – brushing hair. Then the heart slows down guess what she does? She is also doing valsalva manuerver. If you raise your hand over your head you tend to hold your breath a little bit then when you are brushing your hair that too is valsalva manuever.

In fact, where is most MI happens? At home right? Where exactly what room in the home? In the bathroom! And what activity? Taking a shower, washing their hair that’s where most MI occurs.

NSG CARE:
PRE: teach about it. Should wear a loose shirt with buttons up the front. Rationanale: if you use sweater on then when you got wet it is uncomfortable to take it out. Avoid magnet or electrical blanket
POST: remove all the electrodes wrap up the H.M. And bring it back along with the book.

Diabetic Diet

There are many people around the globe who are diabetic. It is really necessary to know about their diet.

DIABETIC DIET – The purpose of it is to maintain the normal ideal body weight and to get that plasma glucose level close to normal as possible. According to the ADA (American diet Association) come up with little change in this. This one maintains normal plasma glucose level. The reality of getting it close normal is impossible with diabetes. What the ADA recommends now is not normal but steady. We don’t want 110 today and 300 tomorrow. Steady if it end up 150, 160 but steady is much better than 110 today and 180 tomorrow.

The principle is to avoid sweets, avoid food high in simple sugars like jams, jelly, and cakes, cream, cookies and pies.
Complex carbohydrates like rice, pasta, bread are good but cake is not good. As nurses it is our responsibility to teach diabetic patients to use he exchange list (the normal to make their lives the more compliant they will be).