Care of Patient on Pacemaker-sonia

8/9/2019 Care of Patient on Pacemaker-sonia

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CARE OF PATIENT ONCARE OF PATIENT ON

PACEMAKERPACEMAKER


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WHAT IS A PACEMAKER?WHAT IS A PACEMAKER?

-- A cardiac pacemaker is an electronicA cardiac pacemaker is an electronic

device that delivers direct stimulation ofdevice that delivers direct stimulation of

the heartthe heart


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What is the purpose ofaWhat is the purpose ofa

pacemaker?pacemaker?

-- the purpose of a pacemaker is to initiatethe purpose of a pacemaker is to initiate

and maintain the heart rate when theand maintain the heart rate when the

hearts natural pacemaker is unable to dohearts natural pacemaker is unable to doso.so.


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Pacemaker FunctionPacemaker Function

-- Cardiac pacing refers to the ability of theCardiac pacing refers to the ability of the

pacemaker to stimulate either the atrium,pacemaker to stimulate either the atrium,

the ventricles, or both heart chambers inthe ventricles, or both heart chambers insequence and initiate electricalsequence and initiate electrical

depolarization and cardiac contraction.depolarization and cardiac contraction.

-- Cardiac pacing is evidenced on the ECGCardiac pacing is evidenced on the ECG

by the presence of a spike or pacingby the presence of a spike or pacingartifactartifact


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Nursing ManagementNursing Management

I. Maintain cardiac outputI. Maintain cardiac output

1. Record the following information after1. Record the following information after

insertion of the pacemakerinsertion of the pacemaker1.0 pacemaker manufacturer,1.0 pacemaker manufacturer,

model, and lead typemodel, and lead type

1.1

operating mode (based on1.1

operating mode (based onICHD code)ICHD code)


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1.2 programmed settings:1.2 programmed settings:

lower rate limit; upper ratelower rate limit; upper rate limit;limit;

AV delay; pacing AV delay; pacing thresholdthreshold


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2.Attach ECG electrodes for continuous2.Attach ECG electrodes for continuous

monitoring of heart rate and rhythmmonitoring of heart rate and rhythm

3.Monitor vital signs every 15 minutes until3.Monitor vital signs every 15 minutes until

stable; then as directed.stable; then as directed.4.Monitor urine output and level of4.Monitor urine output and level of

consciousnessconsciousness

5. Observe for the presence of dysrhyhtmias5. Observe for the presence of dysrhyhtmias6. Obtain 126. Obtain 12--lead ECG daily as directedlead ECG daily as directed


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II. Avoiding injuryII. Avoiding injury

1. chest x1. chest x--rayray

2. monitor for signs/symptoms of2. monitor for signs/symptoms of

hemothorax or pneumothoraxhemothorax or pneumothorax3. evaluate continually for bleeding3. evaluate continually for bleeding

4. monitor for evidence of lead4. monitor for evidence of leadmigration and perforation of heartmigration and perforation of heart

5. provide an electrically safe5. provide an electrically safeenvironment for patientenvironment for patient


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6.Be aware of hazards in the hospital6.Be aware of hazards in the hospitalenvironment that can interfere withenvironment that can interfere withpacemaker function or cause pacemakerpacemaker function or cause pacemakerfailure and/ or permanent pacemakerfailure and/ or permanent pacemaker

damage.damage.7.Prevent possible accidental pacemaker7.Prevent possible accidental pacemaker

malfunctionmalfunction

8.Monitor for electrolyte imbalances,8.Monitor for electrolyte imbalances,hypoxia, and myocardial ischemiahypoxia, and myocardial ischemia


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III. Preventing infectionIII. Preventing infection1. take temperature every 4 hours;1. take temperature every 4 hours;

report elevationreport elevation

2. observe incision site for s/s of local2. observe incision site for s/s of local

infectioninfection3. be alert to manifestation of3. be alert to manifestation of

bacteremeabacteremea

4. clean incision site using sterile4. clean incision site using sterile

techniquetechnique


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5. monitor vein for evidence of phlebitis5. monitor vein for evidence of phlebitis

6. evaluate patients complaints of6. evaluate patients complaints of

increasing tenderness and discomfort onincreasing tenderness and discomfort on

incision siteincision site7. Administer antibiotic therapy as7. Administer antibiotic therapy as

prescribedprescribed


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IV. Relieving anxietyIV. Relieving anxiety1. Explain procedures, treatments and1. Explain procedures, treatments and

answer the patients questions withanswer the patients questions withconcise explanationconcise explanation

2. Encourage patient to use coping2. Encourage patient to use copingmechanisms to overcome anxietymechanisms to overcome anxiety

3. Monitor for unwarranted fears3. Monitor for unwarranted fearsexpressed by the patient and provideexpressed by the patient and provide

explanation to alleviate fearexplanation to alleviate fear4. Encourage patient to accept4. Encourage patient to acceptresponsibility of careresponsibility of care


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V. Minimizing theeffect of immobilityV. Minimizing theeffect of immobility1. bed rest for 24 to 48 hours and1. bed rest for 24 to 48 hours andimmobilization of extremity nearestimmobilization of extremity nearestto permanent or temporaryto permanent or temporary

pacemaker lead implant (allowspacemaker lead implant (allowsstabilization of leads in the heart andstabilization of leads in the heart andprevent dislodgement)prevent dislodgement)

2. Promote pulmonary function2. Promote pulmonary function

3. Promote venous return and prevent3. Promote venous return and preventstasisstasis


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4. restrict movement of the affected4. restrict movement of the affectedextremityextremity

5. Assist patients with activity of daily livings5. Assist patients with activity of daily livings

as appropriate.as appropriate.


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VI Relieving painVI Relieving pain

1. Prepare patient for discomfort that1. Prepare patient for discomfort that

maybe experienced aftermaybe experienced after

pacemaker implant or initiation ofpacemaker implant or initiation oftranscutaneous pacing.transcutaneous pacing.

2. Administer analgesic as prescribed.2. Administer analgesic as prescribed.

3. Offer back rubs to promote3. Offer back rubs to promoterelaxation.relaxation.


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4. Provide patient with diversional activities.4. Provide patient with diversional activities.

5. Evaluate effectiveness of pain5. Evaluate effectiveness of pain--relievingrelieving

modalitiesmodalities..


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VII. Maintaining a Positive Body ImageVII. Maintaining a Positive Body Image1. Encourage the patient to express1. Encourage the patient to express

concerns regarding selfconcerns regarding self--image andimage andpacer implants.pacer implants.

2. Reassure pt. that sexual activity and2. Reassure pt. that sexual activity andmodes of dressing will not altered bymodes of dressing will not altered bypacemaker implantation.pacemaker implantation.


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3.Offer the pt. the opportunity to talk to3.Offer the pt. the opportunity to talk to

others who have had a pacemakerothers who have had a pacemaker

implantation.implantation.

4.Encourage spouse of pt. or significant4.Encourage spouse of pt. or significant

other to discuss concerns of self imageother to discuss concerns of self image

with the patient.with the patient.


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VIII.Health

teach

ingsVIII.Health

teach

ings

.

.1. Teach your client on self care.1. Teach your client on self care.

2. Promote safety.2. Promote safety.

3. Importance of periodic device3. Importance of periodic device

monitoringmonitoring

4. Avoiding infection.4. Avoiding infection.

5. Avoiding EMI5. Avoiding EMI

6. Share information about activities6. Share information about activitiesthat are safe and those that may bethat are safe and those that may bedangerous.dangerous.

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Care of Patient on Pacemaker-sonia

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