# Step 1a: Assessing the Heart Rate (Nursing)

by Rhonda Lawes, PhD, RN

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00:01 Hi, welcome to our video series on electrocardiograms.

00:05 I'm going to show you in seven steps how you can interpret any cardiac rhythm.

00:11 Now, deciphering an ECG strip can be frustrating and overwhelming.

00:16 I remember it was for me.

00:18 So at first, it may feel like you're trying to read a foreign language with each wave and tiny square hiding some secret message.

00:26 And sometimes, that's exactly the case.

00:29 But understanding ECG strips requires practice and effort, just like learning another language does.

00:36 But if you take a systematic approach, stick with us on the seven steps, and you'll be able to crack the code in no time.

00:44 Now, these are the seven steps that will help you unravel the mysteries behind that little strip of paper, right? I've got them listed there. But don't, don't be overwhelmed.

00:54 We're going to go through them one at a time to make sure you feel confident on each of the steps.

00:59 So we have them listed here, just so you can see them all together.

01:04 I want you to take a look at step one has two parts.

01:07 It's the rate and the rhythm.

01:09 The other steps will just involve one step.

01:13 So let's begin with step one, and assess the heart rate and assess the heart rhythm.

01:19 So, 1A and 1B.

01:21 Now, assessing the heart rate includes assessing both the atrial rate and the ventricular rate.

01:27 I know that might sound kind of weird, but some people are not really communicating very well between their atrium or their ventricle or there's something going on.

01:35 So you want to look at each rate differently.

01:38 So step 1A, you're going to assess the heart rate, looking at both the atrial rate and the ventricular rate.

01:46 But first, you're going to need to identify a six second section of a strip.

01:51 Whew, I'm just got it, I made it through that six second section of a strip.

01:56 So let's dive into that first step.

01:58 If we're looking at the heart rate, you first need to identify a six second section of the ECG strip.

02:05 So how do you do that? We'll take a look at the ECG paper.

02:10 You'll see there's tiny squares, and there's big squares.

02:14 Five of these big squares add up to one full second.

02:17 That means that 15 big squares will equal... do the math, three seconds, and of course, 30 big squares will be six seconds.

02:27 Now, here's an easier way to do it.

02:29 Go ahead and look for these hash marks, you'll see them up on the slide.

02:35 And that will tell you, there are three seconds in between the first hash mark and the second one, and three seconds between the second hashmark at the top and the last one.

02:45 Now keep in mind, when we're looking at heart rate, if you have an ECG strip, you also have a patient on a monitor.

02:53 So the monitor will tell you exactly what that heart rate is.

02:57 We're just getting a pretty solid estimate.

03:00 We could show you another way to measure R to R and hold it down on the paper, but that's not really necessary.

03:05 Because you guys will have the patient on a monitor, you'll always check their pulse, match it with the number on the screen to make sure that that's consistent.

03:14 And right now, this is just a quick way to figure out what the heart rate is.

03:19 Where we can calculate the atrial and ventricular rate on this strip.

03:23 So to calculate the atrial rate, you're going to count the P waves and multiply by 10.

03:28 Wait a minute, that's more math.

03:30 So why are we doing that? Well, you want to know how many atrial beats per minute.

03:37 We've established that this is a six second strip.

03:41 So in order to get one minute, I multiply 6 x 10.

03:46 So if I want to see what the atrial rate is, I would count the P waves and multiply that by 10 and that will tell me, how many atrial beats per minute.

03:55 Now, let's count the ventricular rate.

03:58 You do that by counting the QRS complexes and you multiply those by 10.

04:03 That will tell you how many beats you have a minute of the ventricle.

04:07 Now, the idea is that we have one atrial beat for every ventricular beat, or one P wave for every QRS.

The lecture Step 1a: Assessing the Heart Rate (Nursing) by Rhonda Lawes, PhD, RN is from the course The Basics of ECG Strips (Nursing).

### Included Quiz Questions

1. P waves
2. T waves
3. QRS complexes
4. ST-segments
1. Six seconds
2. One second
3. Three seconds
4. 0.04 seconds

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