Objective 4 and 5.txt

nonsurgical;provides a timed electrical stimulus to the heart when the impulse initiation or the conduction system of the heart is defective. The electrical stimulus then spreads throughout the heart to depolarize the cells which should then be followed by contraction and cardiac output. It may be delivered to the right atrium or right ventricle (single chamber pacemakers) or both (double chamber pacemaker). When a pacing stimulus is delivered to the heart, a spike is seen as a P wave (atrial depolarization) or QRS complex (ventricular depolarization); used for patients with symptomatic atropine-refractory bradydysrhythmias or patients with asystole

application of two large external electrodes which are attached to an external pulse generator. The generator emits electrical pulses which are transmitted through the electrodes and then transcutaneously to stimulate ventricular depolarization when the patient’s heart rate is slower than the rate on the pacemaker

Directly to heart after open heart surgery

through a vein and lodged into wall of rt ventricle, rt atrial or double chamber

on crash cart

asynchronous; constant rate without regard for heart’s activities

synchronous; preset rate only if HR below certain level

can override or deliver electric shock

infection, hematoma, ectopic complexes, loss of capture, over or undersensing, electromagnetic interference, stimulation of the chest wall or diaphragm (contraction of chest wall or hiccups) which could cause cardiac tamponade

insulate wire ends to prevent microshock; equipment properly grounded; wear rubber gloves

treat conduction disorders that are not temporary including heart block; 10 year life span

assess pt knowledge, consent

clean skin with soap and water; trim hair; posterior electrode between spine and left scapula; anterior on heart (don’t place on bone)

monitor patient status, meds (pain, antiarrhythmia), set pacemaker settings

document time, date, model, setting; monitor HR and rhythm; chest xray (pneumothorax and hemothorax); pain med; minimize shoulder movement; pt safety; monitor for hiccups (can indicate pacer is pacing in diaphragm

battery failure; infection; dizziness, weakness or chest pain; ID card; how to take pulse; loose clothing; SOB; airport concerns; no electrical appliances on top; transmitter towers; move away from devices causing unusual feelings; cell phones on opposite side; no contact sports

infection, hematoma, pneumothorax, hemothorax, arrhythmias; monitor CBC and breathing sounds and chest movement; may see PVCs, monitor BP

monitor function and tolerance; incision site; coping; knowledge deficit

infection, ineffective coping, knowledge deficit

no infection, adhere to self-care program, effective coping, maintainence of device function; let pt express feelings, stress reduction

reason-MI, electrolyte imbalances or bad voltage; can decrease amplitude per doctor’s order

pacemaker does not recognize normal beats and generates an unnecessary pacemaker spike

replace lead or battery; access pt for murmur

stimulation of chest wall or diaphragm (hiccup) which can lead to cardiac tamponade; microshock-can lead to cardiac arrhythmias; cover wires with gauze; change in pacing QRS shape; septal perforation; myocardial wall perforation (turn off pacer)

chamber paced, chamber sensed, response mode, programmable functions, tachydysthyrhmic functions

bradycardia, complete heart block, sinus arrest, asystole, atrial or ventricular tachydysrhythmias

dizziness, palpitations, chest pain or pressure, anxiety, fatigue, nausea, breathing difficulties

brady or tachy, abnormal EKG, dyspnea or tachypnea, restlessness, JVD, vomiting, hypotension, diaphoresis, decreased cardiac output