Objective 4 and 5.txt

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Objective 4 and 5.txt
2013-09-02 14:16:47

Objective 4 and 5
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  1. Temporary pacing
    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
  2. Noninvasive temporary pacing
    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
  3. Palpate right radial or carotid pulse
  4. Epicardial
    Directly to heart after open heart surgery
  5. Endocardial
    through a vein and lodged into wall of rt ventricle, rt atrial or double chamber
  6. Transcutaneous pacemaker
    on crash cart
  7. Fixed rate
    asynchronous; constant rate without regard for heart’s activities
  8. Demand mode
    synchronous; preset rate only if HR below certain level
  9. Antidysrhythmic function
    can override or deliver electric shock
  10. Complications of invasive temporary pacing
    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
  11. Safety for pacemaker
    insulate wire ends to prevent microshock; equipment properly grounded; wear rubber gloves
  12. Permanent pacemaker
    treat conduction disorders that are not temporary including heart block; 10 year life span
  13. Pacemaker preprocedure nursing actions
    assess pt knowledge, consent
  14. Transcutaneous pacing
    clean skin with soap and water; trim hair; posterior electrode between spine and left scapula; anterior on heart (don’t place on bone)
  15. During procedure
    monitor patient status, meds (pain, antiarrhythmia), set pacemaker settings
  16. Pacemaker post procedure
    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
  17. Pacemaker education
    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
  18. Pacemaker complications
    infection, hematoma, pneumothorax, hemothorax, arrhythmias; monitor CBC and breathing sounds and chest movement; may see PVCs, monitor BP
  19. Nursing process for pacemaker
    monitor function and tolerance; incision site; coping; knowledge deficit
  20. Nursing DX for pacemaker
    infection, ineffective coping, knowledge deficit
  21. Goals for pacemaker
    no infection, adhere to self-care program, effective coping, maintainence of device function; let pt express feelings, stress reduction
  22. Pacemaker malfunction
    reason-MI, electrolyte imbalances or bad voltage; can decrease amplitude per doctor’s order
  23. Failure to sense
    pacemaker does not recognize normal beats and generates an unnecessary pacemaker spike
  24. Failure to output
    replace lead or battery; access pt for murmur
  25. Pacemaker malfunction
    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)
  26. 5 letter system to identify pacemaker function
    chamber paced, chamber sensed, response mode, programmable functions, tachydysthyrhmic functions
  27. Why would one need a pacemaker
    bradycardia, complete heart block, sinus arrest, asystole, atrial or ventricular tachydysrhythmias
  28. Subjective date on pacemaker pt
    dizziness, palpitations, chest pain or pressure, anxiety, fatigue, nausea, breathing difficulties
  29. Objective data on pacemaker pt
    brady or tachy, abnormal EKG, dyspnea or tachypnea, restlessness, JVD, vomiting, hypotension, diaphoresis, decreased cardiac output