Transcript Pacemakers
Group 4 Presenting topics: Defibrillation, Cardioversion, Permanent pacemaker, & Implantable cardioverter/defibrillator (ICD) By: Joowon, Jimmy & Megan A synchronized counter shock that can be performed in emergencies or as an elective procedure to restore an abnormal heart rhythm back to normal. Used to treat ventricular or supraventricular tachydysrhythmias . The shock works by depolarizing the myocardium and allowing the sinus node to regain control of the heart. Emergency equipment must be present during the cardioversion. Consent form must be signed (unless it is a life-threatening emergency). Short-acting anesthetic should be administered prior to shock. Ensure all personnel have cleared contact before the shock is delivered. An asynchronous counter shock that depolarizes the myocardium while allowing the sinus node to regain control of the heart. Used in the treatment of pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF). Effective CPR should continue until defibrillator is available. Before defibrillation, make sure to loudly command all personnel to stand clear of the patient and bed. Resume CPR immediately after the shock and continue CPR for 5 cycles or two minutes, then reassess the patient’s heart rhythm. Administer a second shock if indicated and repeat CPR cycle. Remember to follow your facility’s ALS protocol! Maintain patent airway. Administer oxygen. Assess vital signs & LOC. Administer antidysrhythmic drugs as prescribed. Monitor for dysrhythmias. Assess for chest burns from electrodes. Provide emotional support. Document the results. Device used to detect and terminate ventricular tachycardia (VT) or ventricular fibrillation (VF). Consists of a lead system. Battery- powered generator implanted subcutaneously in pectoral area. Insertion procedure similar to pacemaker. Placed via subclavian vein to the endocardium. Physician can activate/deactivate with the use of magnet over the site. Have spontaneous sustained VT or VF. Survived from sudden cardiac death (SCD). Have syncope with VT or VF during electrophysiological studies. Future high risk for dysrhythmias. When the ICD has detected lethal VT or VF, the defibrillating device delivers a shock to the patient’s heart. If the first attempt is not successful, the generator recycles and can continue to deliver shocks. Continue prescribed medications as ordered. Sit or lie down when experiencing internal defibrillator shock and immediately call the MD. Notify your physician for fever, redness, swelling, soreness or drainage from site. Report for fainting, nausea, weakness, blackout, tachycardia to your MD. Follow restrictions of your diet and physical activities. Report to medical professionals about your ICD before any testing/lab work done to prevent ICD malfunction. MRI is contraindicated. Stay away from strong electromagnetic field sources. Beeping sounds indicate the patient to move away from the area, to prevent ICD deactivation or malfunction. Cell phones must be at least 6 inches away from the ICD generator. Always carry your ICD identification card and wear medical alert bracelet. CPR class is highly recommended to family members/caregivers. Know the access of the emergency medical services (EMS) systems. What is it? - A pacemaker is an implantable electronic device that delivers electrical stimulation to the heart to help regulate it’s beat. Indications - Permanent pacemakers are indicated for chronic or recurrent dysrhythmias due to sinus or AV node malfunction. Structures 1) Pulse generator 2) Lead 3) Electrode Take pulse for 1 full minute at the same time each day. Report any fever or any redness, swelling, or drainage at the insertion site. Report signs of dizziness, fainting, fatigue, weakness, chest pain, hiccupping, or palpitations. Keep cellular phones at least 6 inches away from the generator. Carry a pacemaker identification card. Avoid sources of strong electromagnetic fields. MRI is contraindicated. Do not apply pressure over your generator. Teach that batteries last 10 years on average. Inform airport personnel of your pacemaker. Household appliances should not affect pacemaker function unless held directly over pacer generator. A nurse is preparing a teaching plan for a client who recently underwent surgery for insertion of a permanent pacemaker. Which instruction should the nurse include in the teaching plan? ( Select all that apply.) 1) Check your HR for 1 minute daily. 2) Check your respiratory rate for 1 minute daily. 3) Report bulging at the insertion site. 4) Report redness, swelling, or discharge at the insertion site. 5) Stay away from airport metal detectors. 6) Avoid magnetic resonance imaging(MRI) studies Answer: 1,4,6 2) Check your respiratory rate for 1 minute daily. Daily respiration check is not necessary. 3) Report bulging at the insertion site. Slight bulging is normal 5) Stay away from airport metal detectors. It is safe to go through an airport detector but may activate the metal detector. The client has now received a permanent pacemaker. Which of the following statements indicates a need for further teaching? 1) “ I will notify the airport screener about my pacemaker.” 2) “ I will call if I notice hiccups or muscle twitching.” 3) “ I need to disconnect my garage door opener.” 4) “ I will take my pulse every morning when I awake.” Answer: 3 3) “ I need to disconnect my garage door opener.” Household appliances will not affect pacemakers. The nurse plans care for the patient with ICD based on the knowledge that: 1) Drugs for dysrhythmias will be discontinued. 2) All family members/caregivers of the patient should learn CPR. 3) 1 week after implantation, the patient should not drive. 4) The patient is usually relieved to have the device to prevent dysrhythmias. Answer: 2 All family members/caregivers of the patient should learn CPR. Adult Medical-Surgical Nursing RN ATI (7.1 ed.). (n.d.). [Defibrillator]. (n.d.). Retrieved from http://www.optmedical.com/ defibrillator.html Ignatavicius, D. D., & Workman, L. M. (n.d.). Medical-Surgical Nursing (6th ed.). St. Louis, Missouri: Saunders. (Original work published 2010) Lewis, S. L., & Heitkemper, M. M. (2007). Medical-Surgical Nursing (7th ed.). St Louis, Missouri: Mosby. [Pacemaker] [Painting]. (2011, January 16). Retrieved from http://lostpedia.wikia.com/wiki/Pacemaker Springhouse. (n.d.). Incredibly easy “Nclex Review" (3rd ed.). Lippincott Williams & Wilkins.