Medical Terminology and Procedures, Exams of Community Health

Download Medical Terminology and Procedures and more Exams Community Health in PDF only on Docsity! 1 Chief Complaint Definition The reason why the patient came to see the physician. Chief Complaint Abbreviation CC History of Present Illness Abbreviation HPI History of Present Illness Definition This is an explanation of the CC to determine the onset of the illness; associated symptoms; what the patient has done to treat the condition, etc. Past, Family and Social History Abbreviation PFSH Past Medical History Definition Includes all health problems, major illnesses, surgeries the patient has had, current medications complete with reasons for taking them, and allergies. Family History Definition 2 Summary of health problems of siblings, parents, and other blood relatives that could alert the physician to hereditary and/or familial disease. Social History Definition Includes marital status, occupation, educational attainment, hobbies, use of alcohol, tobacco, drugs, and lifestyles. Review of Systems Abbreviation 5 97.6F to 99.6F 36.5C to 37.5C Normal Temperature Range for Axillary 96.6F to 98.6F 35.9C to 37.0C Normal Temperature Range for Tympanic Membrane 98.6 F 37 C Define Febrile Presence of Fever Define Afebrile Absence of Fever Define Fever Elevated body temperature beyond normal range. Intermittent Fever 6 Fluctuating fever that returns to or below baseline then rises again. Remittent Fever Fluctuating fever that remains elevated; it does not return to baseline temperature. Continuous Fever 7 A fever that remains constant above the baseline; it does not fluctuate. Oral Temperature Is the most common method of measurement. Oral Temperature is not taken from what patients: -infants and children less than six years’ old -patients who has had surgery or facial, neck, nose, or mouth injury -those receiving oxygen -those with nasogastric tubes -patients with convulsive seizure -hemiplegic patients -patients with altered mental status How long after a patient eats, smokes or drinks do you wait to take an oral temperature? 30 minutes When taking an oral temperature how long do you leave the thermometer in the patient's mouth? 3-5 minutes 10 What is the normal range for an adult pulse? 60 to 100 beats per minute The site most commonly used for taking a pulse is: The radial artery (found in the wrist on the same side as the thumb). When taking a pulse at the radial artery it is felt with the: First two or three fingers (never with the thumb) and usually taken for 30 seconds multiplied by two to get the rate per minute. 11 (Taking a pulse at the radial artery) If the rate is unusually fast or slow then: Count it for 60 seconds The is a more accurate measurement of the heart rate and it is taken over the apex of the heart by auscultation using the stethoscope. Apical Pulse Taking an apical pulse is used for patients with: Irregular heart rate and for infants and small children. Respiratory Characteristics Rate, Rhythm, and Depth Respiratory Rate Is the number of respirations per minute. Normal Adult Range of Respiratory Rate 12 to 20 per minute What counts as one respirations: 12 One inspiration (inhale) and One Expiration (exhale). How is a Respiratory Rate calculated? Count respirations for 30 seconds then multiplied by two or count for a full minute. Define Apnea 15 Define Hyperpnoea: Abnormal increase in the depth and rate of breathing. Define Hyperventilation: State in which there is an increased amount of air entering the lungs. Define Blood Pressure: This is the measurement of the amount of force exerted by the blood on the peripheral arterial walls and is expressed in millimeters (mm) of mercury (Hg). Blood Pressure Abbreviation BP BP consist of two components: The Highest (systole) and lowest (diastole) amount of pressure exerted during the cardiac cycle. Common errors in blood pressure measurements: -Improper Cuff Size -The arm is not at heart level -Cuff is not completely deflated before use 16 -Deflation of the cuff is faster than 2-3mmHG per second -The cuff is re-inflated during the procedure without allowing the arm to rest for 1-2 minutes between reading -Improper cuff placement -Defective Equipment Define Anthropometric Measurements 17 Refers to comparative measurements of the body. What age groups use Length, Height, Weight, Weight-for-Length, and Head Circumference - Anthropometric Measurements: Are used to assess growth and development in infants, children, and adolescents. What age groups use Height, Weight, Body Mass Index (BMI), waist-to-hip ratio, and % of body fat - Anthropometric Measurements: Are the measurements used for adults. The 4 principles of a physical examinations: Inspection, Palpation, Percussion, Auscultation Define Inspection Which provided an enormous amount of information. The observer uses observation to detect significant physical features or objective data. Inspection focuses on certain aspects of the patient: General Appearance, State of Nutrition, Body Habitus, Symmetry, Posture and Gait 20 Dorsal Lithotomy Position Is used for examination of pelvic organs. This position is similar to the dorsal recumbent position, except that the patient's legs are well separated and thighs are acutely flexed. The feet are usually placed in stirrups and a folded sheet or bath blanket is places crosswise over thighs and legs so that genital area is easily exposed. 21 The Pone Position Is used to examine the back. The patient lies on his/her abdomen with head turned to one side for comfort, the arms may be above head or alongside the body. The Sim's Position Is used for rectal examination. The patient is on his/her left side with the right knee flexed against the abdomen and the left knee slightly flexed. The left arm is behind the body; the right arm is placed comfortable. The Knee-Chest Position Is used for rectal or vaginal examinations and as treatment to bring uterus into a normal position. The patient is on his/her knees with his/her chest resting on the bed and elbows resting on the bed or arms above head. The head is turned to one side. Trendelenburg Position The patient is placed flat on the back, face up, the knees flexed and legs hanging off the end of the table, with the legs and feet supported by footboard. The table is positioned with the head 45 degrees lower than the body. This position is used primarily for surgical procedures of pelvis and abdomen. OSHA stands for Occupational Safety and Health Administration 22 OSHA is Responsible for the identification of the various hazards present in the work place and for the creation of rules and regulations to minimize exposure to such hazards. Physical Hazards - Electrical Safety Regulations: 25 -Tell those caring for you about any worries that you have about taking pain medications -Decide if you want your family and/or significant others to aid in your relief of pain Patient Representative Primary assignment is to assist you in exercising your rights as a patient. Good Samaritan Law This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury. Needle Stick Prevention Act OSHA has put into force the Occupational Exposure to Blood borne Pathogen (BBP) Standard when it was concluded that healthcare employees face a serious health risk as a results of occupational exposure to blood and other boy fluids and tissues. Blood borne Pathogen Abbreviation BBP Blood borne Pathogen Standard -Revision and updating of the exposure control plan 26 -Solicitation of employee input in selecting engineering and work practice controls -Modification of definitions relating to engineering controls -New record keeping requirements Sharps Injury Log must contain, at the minimum: -The type and brand of device involved in the incident 27 -The department or work area where the exposure incident occurred -An explanation of how the incident occurred Define Tort Is a wrongful act that results in injury to one person by another. Define Battery The basis of tort in this case is the unprivileged touching of one person by another. When a procedure is to be performed on a patient, the patient must give consent in full knowledge of the procedure and the risk it entails (informed consent). Define Invasion of Privacy This is the release of medical records without the patient's knowledge and permission. Define Defamation of Character This consists of injury to another person's reputation, name, or character through spoken (slander) or written (libel) words. Define Negligence 30 Define External Hemorrhage Controlling the bleeding is most effectively accomplished by elevating the affected part above heart level and applying direct pressure to the wound. Do not attempt to elevate a broken extremity as this could cause further damage. 31 Define Shock Occurs when there is insufficient return of blood flow to the heart, resulting in inadequate supply of oxygen to all organs and tissues of the body. Common Shock Symptoms: -Pale, Cold, Clammy Skin -Rapid, Weak Pulse -Increased, Shallow Breathing Rate -Expressionless Face/Staring Eyes First Aid for Shock -Maintain an open airway for the victim -Call for assistance -Keep the victim lying down with the head lower than the rest of the body -Attempt to control bleeding or cause of shock (if known) -Keep the victim warm until help arrives Define Cardiopulmonary Resuscitation Most healthcare institutions require their professionals to be certifies in CPR. It is important for all professional to maintain all certifications acquired. 32 CPR stands for Cardiopulmonary Resuscitation Define Urinary Bacteria Enteric gram-negative bacteria that are always nitrite positive can convert urinary nitrate to nitrite. A positive nitrite test is an indication that a significant number of bacteria are present in the urine. 35 UCG Increased levels of hCG are a natural marker for . Pregnancy Define Hemoccult Fecal Occult Test Is used to detect hidden blood in stool specimens. The 1st and last portion of the stool after the bowel movement usually contain concentrations of the substances most often required for testing. In order to conduct this test, a Hemmocult developing solution is applied to a stool specimen. Any trace of blue that appears within the specimen is a sign of a positive result. Define Throat Culture Are used to detect a bacterial, fungal, or ciral infection in the throat. In order to conduct this test, the patient should be placed in a comfortable lying or sitting position. After the patient have been asked to open their mouth, the MA should depress the patient's tongue then vigorously swab the throat with a sterile swab. After the specimen is collected, it should be correctly labeled with the patient's information. Define Sputum Specimen Is used to determine the presence of pathogens in a patient's respiratory passage. When obtaining the specimen, the MA should instruct the patient to cough deeply, using the abdominal muscles as well as the accessory muscles to bring up secretions from the lungs as well as the upper airways. After the specimen is collected, it should be correctly labeled with the patient's information. 36 Order of Draw for Capillary Specimens 1. Lavender Tube 2. Tubes with other additives 3. Tubes without additives 37 PKU This test is ordered for infants to detect phenylketonuria, a genetic disease that causes mental retardation and brain damage. Test is done on blood from newborn's heel or on urine. Order of Draw (Because Better Specimens Generate Perfect Goals) 1. Blood Cultures 2. Light Blue Top Tubes 3. Serum or non-additive tube (Red or Red/Gray Top Tubes) 4. Green Top Tubes 5. Lavender Top Tubes 6. Gray Top Tubes Define Infection Control/Chain of Infection Based on the fact that the transmission of infectious disease will be prevented or stopped when any level in the chain is broken or interrupted. Define Agents Are infectious, microorganisms that can be classified into groups namely: viruses, bacteria, fungi, and parasites. Define Portal of Exit The method by which an infectious agent leaves it reservoir. 40 What methods are used to limit the transmission of infectious agents: -Wound Care -Transmission-Based Precautions -Aseptic Technique Define Susceptible Host 41 The infectious agent enters a person who is not resistant or immune. Control at this level is directed towards the identification of the patients at risk, treat their underlying condition for susceptibility, or isolate them from the reservoir. Define Medical Asepsis The destruction of pathogenic microorganisms after them leave the body. It also involves environmental hygiene measures such as equipment cleaning and disinfection procedures. Define Disinfection This procedure used in medical asepsis using various chemicals that can be used to destroy many pathogenic microorganisms. Since chemicals can irritate skin and mucous membranes, they are only used on inanimate objects. Boiling water at what temperature is considered a form of disinfected: 212 F What is the ratio of bleach and water is a disinfected: 1:10 Define Surgical Asepsis All microbial life, pathogens, pathogens and non-pathogens, are destroyed before an invasive procedure is performed. Often used interchangeably. 42 4 Methods of Sterilization -Gas Sterilization -Dry Heat Sterilization -Chemical Sterilization -Steam Sterilization 45 Abbreviation for Personal Protective Equipment PPE PPE Includes: -Mask -Goggles -Face Shields -Respirator Define Chemical Examination of Urine This involves the chemical evaluation of the contents of the urine which can be qualitative or quantitative. Chemical Examination of Urine Involves: -pH -Glucose -Ketone -Protein -Blood -Bilirubin -Urobilinogen -Nitrite -Leukocyte Esterase 46 Define Microscopic Examination of the Urine Is done on urine sediment obtained by centrifugation of 10 to 15ml of urine. The identification and enumeration of the urinary sediment constituents require that only highly skilled and qualified individuals undertake the microscopic examination. 47 Define Specific Gravity of Urine Is the ratio of the weight of given volume of urine to the weight of the same volume of distilled water at a constant temperature. This is the most convenient way of measuring the kidney's ability to concentrate and dilute. During a 24-hour period, normal adults with normal diets and normal fluid intake produce urine with a specific gravity of between and . 1.015 and 1.025 The normal range of urine specific gravity for a random collection is to . 1.002 to 1.030 Define Urinary pH Is the reflection of the acidity or alkaline of solution. Define pH The % of hydrogen ion concentration of a solution. 50 Define Oliguria Decreased urinary output. Define Polyuria Increased urinary output. Define Anuria Little to no urine output. 51 Define Routine Urinalysis Examination of the urine is a diagnostic tool to detect or monitor certain conditions. 3 Parts of Examination of Urine -Physical Examination -Chemical Examination -Microscopic Examination Physical Examination of Urine -Assessing the volume of the urine specimen to determine if it is adequate for testing -Observing the color and appearance (or character) of the specimen noting the odor. -Measuring the specific gravity. Define Standard Precautions This is an infection control method designed to prevent direct contact with blood and other fluids and tissues by using barrier protection and work control practices. All patients are presumed to be infective for blood-borne pathogens. Standard Precautions are: 52 -Wear gloves when collecting and handling blood, body fluids, or tissue specimen. -Wear face shields when there is a danger for splashing on mucous membranes. -Dispose of all needles and sharp objects in puncture-proof containers without recapping. 55 Is an emerging and important problem in the health care field. Symptoms/Signs of Irritant Contact Dermatitis Scaling, drying, cracking of skin, Symptoms/Signs of Allergic Contact Dermatitis Blistering, itching, crusting (similar to poison ivy reaction). Symptoms/Signs of NRL Allergy IgE/histamine mediated Hives in area of contact with NRL. Cause of Irritant Contact Dermatitis Direct skin irritation by gloves, powder, soaps/detergents, incomplete hand drying. Cause of Allergic Contact Dermatitis Accelerators processing chemicals. Cause of NRL Allergy IgE/histamine mediated NRL proteins; direct contact with or breathing NRL proteins, including glove powder containing proteins, from powdered gloves or the environment. 56 Prevention/Management for Irritant Contact Dermatitis Obtain medical diagnosis, avoid irritant product, consider use of cotton glove liners, consider alternative gloves/products. Prevention/Management for Allergic Contact Dermatitis Obtain medical diagnosis, identify chemical. Consider use of glove liners such as cotton. Use alternative glove material without chemical. Assure glove material is suitable for intended use (proper barrier). 57 Prevention/Management for NRL Allergy IgE/histamine mediated Obtain medical diagnosis, allergy consultation, substitute non-NRL, gloves for affected worker and other non-NRL products. Eliminate exposure to glove powder - use of reduce protein, powder free gloves for coworkers. Clean NRL- containing powder from environment. Consider NRL, safe environment. (Prescription) po From the Latin per os, or "by mouth" or "orally" (Prescription) pr From the Latin per rectum, or "by way of the rectum," by suppository (Prescription) sl sublingual (under the tongue) (Prescription) IV intravenous (Prescription) IM intramuscular (in the muscle) 60 A hollow muscular organ located in the thoracic cavity between the lungs in a space called Mediastinum. The heart is located at the level of the 2nd intercostal. Base The tip of the heart ( ) is located at the level of 5th intercostal and mid- clavicular line on the left. Apex Define Endocardium 61 The innermost layer of the heart. It is a thin layer of epithelium very similar to vessels' endothelium, which covers the inside part of the heart. It forms the lining and folds back onto itself to form the heart valves and also covers the papillary muscles that anchor chordae tendinae, strings of connective tissue that keep in place the AV valves. The function of the Endocardium is: To prevent blood cell destruction and clotting. The Endocardium is: Also the layer in which the heart's conduction system is embedded. Define Myocardium The middle and contractile layer of the heart. The Myocardium is made up of: Special striated muscle fibers with strong connection with each other (intercalated disks) and branches that ensure a unified and simultaneous contraction of all muscle fibers. There is a high concentration of calcium ions in the space between the muscle fibers (interstitial space), which influences the force of the muscle contraction. Define "Heart Skeleton" 62 Is made up of four rings of thick connective tissue. These rings which surround the base of the heart and large vessels, create the cardiac septum, and provide a solid connection between the heart chambers and a strong attachment for the heart valves. Define Pericardium The outermost layer of the heart. Attached with ligaments to the spinal column and diaphragm fixing the heart in its position. Built by two layers of connective tissue. 65 Receives deoxygenated blood returning to the heart from the body via the superior vena cava which carries blood from the upper body and the inferior vena cava which carries blood from the lower body. Receives blood from the coronary sinus; the largest vein that drains the heart muscle's deoxygenated blood. Define Right Ventricle Receives deoxygenated blood from the right atrium which it pumps to the lungs for oxygenation through the pulmonary trunk and then to the pulmonary arteries. Define The Pulmonary Arteries Are the only arteries in the body that carry deoxygenated blood (because they are going away from the heart). Define the Left Atrium Receives oxygenated blood returning from the lungs via the right and left pulmonary veins. Define The Pulmonary Veins The only veins in the body that carry oxygenated blood (because they are going towards the heart). Define Left Ventricle 66 Receives the oxygenated blood from the left atrium and pumps it to the body through the aorta, the largest artery of the body. The Heart Valves Purpose Is to prevent back flow of the blood thereby assuring uni-directional flow thru the heart. The Atrioventricular Valves (AV) are located: 67 Between the atria and ventricles. AV Cusped Valves Characteristics are: -They have tough fibrous rings. -Long and strong leaflets (cuspids). -They have accessory organs, such as papillary muscles and chordea tendinae. Define Tricuspid Valve Is located between the right atrium and the right ventricle. As the name connotes, it has three cusps (or leaflets). Define Bicuspid Mitral Valve Is located between the left atrium and the left ventricle. It has two cusps (or leaflets) and it also called the mitral valve. Define Semilunar Valves They have half-moon shaped leaflets. Semilunar Valves Characteristics -Three Leaflets -Shallow in depth 70 S1 First Heart Sound (Lubb) Occurs during ventricle contraction and the closure of AV valves. S2 Second Heart Sound (Dupp) Occurs during ventricular relaxation when SL valves (Pulmonary and Aortic valves) close. 71 Define Murmurs Are caused by diseases of the valves or other structural abnormalities. Define Heart Rate Is the number of heart contractions per minute. The normal heart rate is to bpm. 60 to 100 Abbreviation for Beats Per Minute bpm Abbreviation for Heart Rate HR Heart rate is controlled by and located in Aortic Arch and Carotid arteries. Chemo-receptors (chemical sensors) and Baro-Receptors (pressure receptors) The heart is under the influence by the autonomic nervous system (ANS) which is subdivided into the and nervous systems. 72 Sympathetic and Parasympathetic Parasympathetic (Vagus Nerve) Generally, has an inhibitory effect via the neurotransmitter. Acetylcholine may cause what to happen: -Slow SA pacemaker and HR 75 Cardiac Output Formula Stroke Volume x HR per/min Peripheral Vascular Resistance Is the force exerted against the blood flow and is determined by the diameter of the vessel. The lower the vascular resistance the less force is needed to eject the blood out of the heart during systole. Blood Pressure Formula Cardiac Output X Vascular Resistance EKG Graphical presentation of heart electricity (voltage) over time. This electricity is created by specialized cells called pacemaker cells. These cells generate electrical impulses spontaneously (without outside influence) and rhythmically (automatically). 4 Cardiac Cell Properties -Automaticity -Excitability -Conductivity -Contractility 76 Define Automaticity The ability to spontaneously trigger electrical impulses without being stimulated by another source. Define Excitability (also called irritability) the ability to respond and react to a stimulus. 77 Define Conductivity The ability to receive and transmit electrical impulses to adjacent cells. Define Contractility A myocardial cell's ability to shorten (or contract) in response to a stimulus. Define Depolarization Occurs when positively charged ions (such as sodium and calcium) rapidly move from outside the myocardial cell membrane to the inside, changing the overall charge from negative to a positive. Define Repolarization Occurs immediately after depolarization and is the movement of positively charged ions back to the outside of the cell, returning the cell back to its original polarized state. A cell must repolarize before it can depolarize again. Absolute Refractory Period Is the 1st phase of repolarization in which a myocardial cell is unable to react to any electrical stimulus. Relative Refractory Period 80 Found within the ventricular endocardium, it consists of a network of small conduction fibers that deliver the electrical impulses from the Bundle Branches to the ventricular myocardium. EKG is a that measures the heart electricity traveling through the conductive system and an important tool for patient's diagnosis. Galvanometer 81 EKG Evaluation: -Monitoring patient's HR -Evaluates injuries to the heart muscle -Evaluates the pacemakers and conductive system function -Evaluate the response toward medication -Provides a baseline record for medical procedure Define Electrode Is a paper, plastic or metal sensor placed on the patient's skin on a specific location and transmit it to the cable. Define Cable Is a wire that connects the electrode to the EKG machine (cardiac monitor). Define Lead Is a recorded tracing of the heart electricity from one or two electrodes that provides a specific view of the heart. Standard Bipolar Limb Leads Record electrical activity in the frontal plane. Electrodes are applied to the left arm (LA), the right arm (RA) and the left leg (LL). These leads record the difference in electricity between two electrodes. 82 Lead I The left arm is positive and the right arm is negative. (LA-RA) Lead II The left leg is positive and the right arm is negative. (LL-RA) 85 Lead aVF The left leg (or foot) is positive and the other limbs are negative. Precordial Chest Unipolar Leads All these electrodes are positive and record the heart electricity in the horizontal plane. They include leads: V1, V2, V3, V4, V5, and V6. V1 Fourth intercostal space, right sternal border. V2 Fourth intercostal space, left sternal border. V3 Equidistant between V2 and V4. V4 Fifth intercostal space, left midclavicular line. 86 V5 Fifth intercostal space, anterior axillary line. V6 Fifth intercostal space, midaxillary line. The Electrocardiographic Grid and Waves The EKG paper is a graph paper with horizontal and vertical lines at 1-mm intervals. A heavy line appears every 5mm. 87 The horizontal axis represents time: 1mm = 0.04 seconds 5mm = 0.2 seconds The vertical axis represents: voltage, measures in millivolts (1/1000 part of a volt) but expressed in millimeters: 0.1mV-1mm. The tracing is marked on the paper by a stylus using . heat The running speed of an EKG machine is . 25mm/sec The EKG machine must be properly standardized so that 1mV will produce a deflection of . 10mm Define Waveform Refers to movement away from the isoelectric line either upward (positive) deflection or downward (negative) deflection. 90 R (r) Wave The first positive deflection produced by ventricular depolarization. S (s) Wave The first negative deflection produced by the ventricular depolarization that follows the first positive deflection, (R) wave. 91 Ventricular Repolarization T Wave and U Wave T Wave The first wave after the QRS complex has the following characteristics: -The deflection produced by ventricular repolarization -It is slightly asymmetric -No more than 5mm in height UWave Is the deflection seen following the T wave but preceding the diastole. -Represents repolarization of Purkinje fibers -Round and symmetric less than 1.5mm in height -A Prominent U wave is due to hypokalemia (low potassium, blood level) PR Segment This segment is measured from the end of the P wave to the beginning of the QRS Complex. ST Segment This segment represents the time of ventricular contraction and the beginning of repolarization of both ventricles. It is measured from end of QRS to the beginning of the T wave. 92 From J point to the onset of the T wave. This segment is compared to the PR segment to help identify myocardial ischemia or injury. PR Interval Is defined as P wave and PR segment and is measured from the beginning of P wave to the beginning of QRS complex. The normal interval is 0.12-0.2 sec. 95 The number of QRS Complexes between 6 sec marks on the EKG paper is multiplied by 10. Used generally for estimating slow or irregular rhythms. Large Boxes Method Count the number of large boxes between two consecutive RR (one RR interval) and divide into 300 for the ventricular rate; and count large boxes between two consecutive P waves for the atrial rate. Used mainly in regular rhythms. Small Boxes One minute have 1500 small boxes (0.04 sec). Count the number of small boxes between an RR interval and divide into 1500. This method is more accurate and is used for regular rhythms only. Sequence Method Select the R that falls on a dark vertical line. Number the next consecutive dark line as 300, 150, 100, 75, 60, and 50. Note where the next R wave falls in relation to the dark lines. That is the heart rate. Assess Rhythm/Regularity The HR is considered regular is all the RR or PP intervals on the EKG leads are equal. If there are changes in their durations the rhythm is irregular. Identify and examine the P waves 96 PP interval and measure the size of the P wave in different leads. Assess interval (PR, QRS, QT) Measure each of these intervals and determine if they are normal. Evaluate ST segments and T waves 97 ST segment elevation or depression and/or T wave abnormalities can suggest the presence of myocardial ischemia or injury. General Evaluation and Conclusion Notify the doctor for any abnormality that you can find on the EKG strip. Arrhyythmias of Sinus Origin Where electrical flow follows the usual conduction pathway but is too fast, too slow, or irregular. Normal Sinus rate is 60-100 beats per minutes If the sinus rate goes beyond 100 per minute, it is called . Sinus Tachycardia If the sinus rate goes below 60 per minute, it is referred to as . Sinus Bradycardia Ectopic Rhythma Electrical impulses originate from somewhere else other than the sinus node.