CARE OF PATIENT ON PACEMAKER

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CARE OF PATIENT ON PACEMAKER
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WHAT IS A PACEMAKER?

• - A cardiac pacemaker is an electronic device
  that delivers direct stimulation of the heart

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What is the purpose of a pacemaker?

• - the purpose of a pacemaker is to initiate and
  maintain the heart rate when the hearts natural
  pacemaker is unable to do so.

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Pacemaker Function

• - Cardiac pacing refers to the ability of the
  pacemaker to stimulate either the atrium, the
  ventricles, or both heart chambers in sequence
  and initiate electrical depolarization and
  cardiac contraction.
• - Cardiac pacing is evidenced on the ECG by the
  presence of a spike or pacing artifact

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Nursing Management

• I. Maintain cardiac output
• 1. Record the following information after
  insertion of the pacemaker
• 1.0 pacemaker manufacturer, model, and
  lead type
• 1.1 operating mode (based on ICHD code)

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• 1.2 programmed settings lower rate
  limit upper rate limit AV delay pacing
  threshold

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• 2.Attach ECG electrodes for continuous monitoring
  of heart rate and rhythm
• 3.Monitor vital signs every 15 minutes until
  stable then as directed.
• 4.Monitor urine output and level of consciousness
• 5. Observe for the presence of dysrhyhtmias
• 6. Obtain 12-lead ECG daily as directed

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• II. Avoiding injury
• 1. chest x-ray
• 2. monitor for signs/symptoms of
  hemothorax or pneumothorax
• 3. evaluate continually for bleeding
• 4. monitor for evidence of lead
  migration and perforation of heart
• 5. provide an electrically safe
  environment for patient

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• 6.Be aware of hazards in the hospital
  environment that can interfere with pacemaker
  function or cause pacemaker failure and/ or
  permanent pacemaker damage.
• 7.Prevent possible accidental pacemaker
  malfunction
• 8.Monitor for electrolyte imbalances, hypoxia,
  and myocardial ischemia

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• III. Preventing infection
• 1. take temperature every 4 hours
  report elevation
• 2. observe incision site for s/s of local
  infection
• 3. be alert to manifestation of
  bacteremea
• 4. clean incision site using sterile
  technique

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• 5. monitor vein for evidence of phlebitis
• 6. evaluate patients complaints of increasing
  tenderness and discomfort on incision site
• 7. Administer antibiotic therapy as prescribed

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• IV. Relieving anxiety
• 1. Explain procedures, treatments and
  answer the patients questions with
  concise explanation
• 2. Encourage patient to use coping
  mechanisms to overcome anxiety
• 3. Monitor for unwarranted fears
  expressed by the patient and provide
  explanation to alleviate fear
• 4. Encourage patient to accept
  responsibility of care

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• V. Minimizing the effect of immobility
• 1. bed rest for 24 to 48 hours and
  immobilization of extremity nearest to
  permanent or temporary pacemaker lead
  implant (allows stabilization of leads
  in the heart and prevent dislodgement)
• 2. Promote pulmonary function
• 3. Promote venous return and prevent
  stasis

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• 4. restrict movement of the affected extremity
• 5. Assist patients with activity of daily
  livings as appropriate.

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• VI Relieving pain
• 1. Prepare patient for discomfort that
  maybe experienced after pacemaker implant
  or initiation of transcutaneous pacing.
• 2. Administer analgesic as prescribed.
• 3. Offer back rubs to promote relaxation.

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• 4. Provide patient with diversional activities.
• 5. Evaluate effectiveness of pain-relieving
  modalities.

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• VII. Maintaining a Positive Body Image
• 1. Encourage the patient to express
  concerns regarding self-image and pacer
  implants.
• 2. Reassure pt. that sexual activity and
  modes of dressing will not altered by
  pacemaker implantation.

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• 3.Offer the pt. the opportunity to talk to
  others who have had a pacemaker implantation.
• 4.Encourage spouse of pt. or significant other to
  discuss concerns of self image with the patient.

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• VIII. Health teachings.
• 1. Teach your client on self care.
• 2. Promote safety.
• 3. Importance of periodic device
  monitoring
• 4. Avoiding infection.
• 5. Avoiding EMI
• 6. Share information about activities
  that are safe and those that may be
  dangerous.