Learning Module: EKG Interpretation and Interventions

Designing a Lesson: Part A

Marjorie Reilly
SUNY Delhi
NURS 601, CRN 10156, Principles of Teaching and Learning
Kirsty Digger
June 9, 2016

Learning Module: EKG Interpretation and Interventions

Curriculum:

ADN

Course:

Nursing 102 (medical surgical nursing)

Topic:

EKG interpretation and interventions

Setting:

Flipped Classroom A) Online Lecture. B) Classroom EKG interpretation

exercises, and case studies. Columbia Greene Community College.

Time for Module:

1-1.5 hour lecture online, One Class day: 3.5 total hours total
(Details in Module Description below).
The exam will be given during a subsequent class, and will use an
additional hour of class time.

Learning Module: EKG Interpretation and Interventions

This module was designed for use with first year, second semester ADN students. The module
will review the cardiovascular circulatory system, and the electrical conduction pathways of the
heart. Students will be instructed in basic single-lead (II) EKG interpretation in order to identify
and treat cardiac arrhythmias. Students will also learn appropriate interventions and care
planning for patients with arrhythmias.
Module Description
This module will be presented using a flipped classroom strategy. Students will be expected to
view the VoiceThread presentations for this learning module before class. The VoiceThreads will
be broken up into 5 parts lasting 10-20 minutes each. The students will be given fill-in-the blank
worksheets and diagrams for cardiac interval measurements, and waveform correspondence to
cardiac electrical activity. These will then be used as references for classroom exercises.
Once in the classroom setting, students will be given a short fill-in-the blank pre-test which will
assess their knowledge of normal cardiac interval measurements, and also their knowledge of
waveform correspondence to cardiac muscle activity. Students will also be given a packet with
cardiac rhythm strips for interpretation, and for use as future reference material. In addition,
students will be given calipers and sample EKG recording paper. Class will begin with the pretests which will carry no credit, but will be reviewed, so that the students will have accurate
information for EKG interpretation exercises.
EKG interpretation will then be demonstrated by the instructor using an ELMO document
camera (Pictured below). After demonstration of approximately 6 EKG tracings using the 3 rate
methods (10X, 1500, sequence, demonstrated at least two times each), students will be instructed

to work in pairs to interpret one strip at a time. After each interpretation by student pairs,
instructor will ask students to guide EKG interpretation by instructor in front of class for
demonstration guided by student input. During this time, interventions for each arrhythmia will
also be discussed, so that students can add this to their resource packet for future study, and as a
resource. After EKG interpretation instruction, demonstration, and practice are completed,
clinical conference time will be used for students to work in small groups on cardiac case studies
which will include EKG interpretation. These case studies will be presented in brief to the class.

ELMO Document Camera

Objectives

After viewing VoiceThread presentation, student will be able to describe the circulatory
system of the heart (Blooms Understandings: Remembering, understanding).
After viewing VoiceThread presentation, student will be able to describe the electrical
conduction pathways of the heart (Blooms Understandings: Remembering,
Understanding).
After viewing VoiceThread presentations, and participating in learning activities in the
classroom, student will be able to demonstrate EKG interpretation (Blooms
Understandings: Remembering, Understanding, Applying, Analyzing, and Evaluating).
After viewing VoiceThread presentations, and participating in learning activities in the
classroom, students will devise, defend and critique appropriate interventions for EKG
arrhythmias (Blooms Understandings: Remembering, Understanding, Applying,
Evaluating, Analyzing, and Creating).
Blooms Taxonomy source (Concordia University, 2016)

Columbia Greene Community College (CGCC) NU 102 Course Outcomes

CGCC NU 102 course outcomes supported by competencies covered in this module:
1.

Utilize critical reasoning skills while providing safe client care.

a.
Identify the nutritional needs of clients with alterations in oxygenation,
fluid and electrolytes, and elimination.
b.
Demonstrate knowledge of pharmacological principles and nursing responsibilities
when administering medications to clients.
Exercise clinical reasoning as clients conditions evolve.
a.
Apply the concepts of homeostasis and adaptation in the care of clients with
alterations in oxygenation, fluids and electrolytes, and elimination.
2.

3.
4.

b.
Accept the clients life-style choices in reference to the health-illness continuum.
Utilize concepts from the behavioral sciences, biological sciences, and humanities in the
nursing care of clients.
6.
Incorporate evidence-based practice to perform nursing skills taught in NU 101 and NU
102 according to agency criteria when in the clinical setting.
7.
a.
Apply the nursing process in administering care to clients.
Begin to utilize technology to optimize client care.
5.

Timeline
The online VoiceThread presentations will be approximately 1-1.5 hours in duration. An
additional 2 hours of class time will be used for demonstration and practice of EKG
interpretation, and discussion of appropriate interventions. Finally, an additional 1.5 hours of
clinical conference time will be used to do cardiac arrhythmia case studies in small groups, to be
presented to the class as a whole.

Learning Module Outline: EKG Interpretation and Interventions

VoiceThread Presentations

VoiceThread 1: Review of the cardiovascular circulatory system

Review normal circulatory pathways and vasculature of the heart

VoiceThread 2: Review of the electrical conduction system of the heart

How this corresponds to intervals on EKG tracing

VoiceThread 3: EKG interpretation

EKG Grid Explanation
Waveform components and the normal values for these intervals
How each of the waveform components corresponds to cardiac muscle
contraction

VoiceThread 4:
8-Step Method of EKG Interpretation. Determination of:
1. Rhythm
2. Rate (10X, 1500, or Sequence methods of rate determination)
3. Evaluation of P-wave
4. P-R Interval
5. QRS duration
6. T-Wave evaluation
7. QT Duration
8. Evaluation of other components (Ectopy, U-waves, etc.)

VoiceThread 5: Appropriate Interventions for Arrhythmias:

Monitoring, assessment, oxygen therapy, medications, cardioversion,
defibrillation, electrolyte management, care planning
Learning Module Outline: EKG Interpretation and Interventions Cont.
Classroom instruction, Demonstration, and Practice

Module pre-test
Instructor demonstration of EKG strips using document camera.
Students will work in pairs to interpret 1 strip at a time.
After completion of strip by student pairs, instructor will demonstrate each interpretation
guided by student input.
Along with each interpretation, interventions for each arrhythmia will be discussed.
Clinical Conference

Cardiac case studies (including EKG interpretation) completed in small groups.

Case studies presented in brief by student groups to class.

Measurement of Objectives

Objectives will be measured by exam.

Areas to be assessed:
A)
B)
C)
D)
E)

Students will describe the circulatory system of the heart.

Students will describe the electrical conduction pathway of the heart.
Students will interpret EKGs.
Students will determine appropriate interventions for arrhythmias.
Students will be evaluated regarding knowledge of medications used in arrhythmia
management.
Outcomes and Outcome Measurement

Outcomes
As a result of this module students will be able to interpret EKG tracings for patients in the
clinical setting. Students will be able to relate these findings to laboratory values, other
diagnostic tests (echocardiogram, stress test, chest x-ray, TEE, etc.), physical assessment
findings, and medication management. Students will also use the skills learned in this module to
inform patient care planning in the clinical setting.
Outcome Measurement
Outcomes will be measured by clinical instructor evaluation of competencies outlined above. In
addition at semesters end, students will be required to create a cardiac case study using data
obtained in the clinical setting, from one or multiple patients, to be presented in VoiceThread.
This case study will include appropriate interpretation of data, and will also include a care
planning component for the clinical scenario presented.

Teaching Strategies
I will use a number of teaching strategies in a predominately flipped classroom format to deliver
and reinforce content. Online lecture presentations (with video clips, video demonstrations, and
concept maps), classroom demonstration with supervised practice, and cooperative team
learning. There will be an online presentations with instruction using narrated PowerPoints,
online video clips, video demonstration and concept maps, which students will be expected to
view before class. There will be 5 separate videos covering content (see outline below), and
students will be given fill-in worksheets and diagrams to be used in conjunction with the videos,
which will be used as resources for the future, and for classroom EKG interpretation exercises,
and as resources for future reference.
Should I have a student request closed captioning, I would upload the VoiceThread Presentations
to YouTube, so that the student could use closed captioning (to support learning preferences or
differences), as I do not believe closed captions are available in the VoiceThread application. I

chose this method of content delivery so that there would be more opportunity for hands-on and
cooperative learning in the classroom, by freeing up time that would otherwise be taken by
classroom lecture. With these strategies, students will be introduced to the content before class
time, so that they will have the rudiments of EKG interpretation before reinforcement and
practice in the classroom. This will maximize the use of class time for skill acquisition,
reinforcement, and mastery. I also chose this particular variety of strategies in order to appeal to
all types of learner, engage the students (and instructor), and also to give the students ample
opportunity to synthesize their knowledge, and apply this knowledge to case studies. I think that
by using this great variety of teaching strategies, many potential barriers to learning are
mitigated, as these modalities offer something for many learning differences or preferences.
I do a significant potential limitation. I have used the flipped classroom in an extremely limited
fashion to date. In addition, thus far, the majority of learners at CGCC are not accustomed to this
model. Although I hope to use this model far more often than I have thus far, there is the chance
that students will be limited by not being accustomed to it. I do think that there is a chance that
they may not watch the videos before class, but do think that the specter of a pre-test, and the
potential inability to fully participate in classroom exercises may mitigate this concern.

Reference
Concordia University. (2013). Its time to update Blooms Taxonomy. Retrieved from
http://education.cu-portland.edu/blog/curriculum-instruction/is-it-time-to-update-bloomstaxonomy/