Exam 1: Pacemakers

c

A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, a. It will be 6 weeks before I can take a bath or return to my usual activities. b. I will notify the airlines when I make a reservation that I have a pacemaker. c. I wont lift the arm on the pacemaker side up very high until I see the doctor. d. I must avoid cooking with a microwave oven or being near a microwave in use.

b

A patient with a sinus node dysfunction has a permanent pacemaker inserted. Before discharge, what should the nurse include when teaching the patient? a. avoid cooking with microwave ovens b. avoid standing near anti-theft devices in doorways c. use mild analgesics to control the chest spasms caused by the pacing current d. start lifting the arm above the shoulder right away to prevent "frozen shoulder"

b

An older adult is admitted to the telemetry unit for placement of a permanent pacemaker because of sinus bradycardia. What is a priority goal for the client within 24 hours after insertion of a permanent pacemaker? a. maintain skin integrity b. maintain cardiac conduction stability c. decrease cardiac output d. increase activity level

Infection

Discharge/Home Care Teach the patient how to monitor their incision site for signs of what?

5

Discharge/Home Care Teach the patient how to take and record their pulse rate. Also, instruct them to assess their pulse daily before arising and to notify the physician if their HR is ____ bpm slower than the preset pacemaker rate

Malfunction

Discharge/Home Care Teach the patient that signs of pacemaker ____________ to report include: -Dizziness -Fainting -Fatigue -Weakness -Chest Pain -Palpitations

Anti-Theft

Discharge/Home Care Teach the patient to avoid prolonged standing in ___________ devices in stores

MRI

Discharge/Home Care The patient must get approval from the physician before having this test, as the magnet can stop the pacemaker

Hiccups

Other Problems A lead positioned near the diaphragm can stimulate these, causing 60 of them in a minute

Perforation

Other Problems Hiccups may occur in extremely thin clients or may indicate a medical emergency with _____________ of the right ventricle by the pacing electrode tip (This is why we do a chest X-ray during post insertion ALWAYS)

Failure to Capture

Pacemaker Problems This problem occurs when the output (energy) from the pacemaker is too low, resulting in a failure to depolarize the ventricle, causing an absence of a mechanical contraction of the ventricle, or no QRS. A spike will be seen, but no QRS complex will result

d

Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? a. The pacemaker prevents or minimizes ventricular irritability. b. The pacemaker paces the atria at rates up to 500 impulses/minute. c. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. d. The pacemaker stimulates a heart beat if the patients heart rate drops too low.

b c d

Which patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker and the caregiver? Select all that apply a. avoid or limit air travel b. take and record daily pulse rate c. obtain and wear a Medic Alert ID device at all times d. avoid lifting arm on the side of the pacemaker above the shoulder e. avoid microwave ovens because they interfere with pacemaker function

Failure to Sense

Pacemaker Problems This problem occurs when the pacemaker fails to read the patient's own intrinsic heart rhythm and generates a pacer spike anyway. This can cause potentially lethal arrhythmias

Sensitivity

Pacemaker Problems When a pacemaker fails to sense, it could be due to the pacemaker's ____________ setting being too low. Nursing interventions include vital signs, checking O2 saturation, notifying the provider, and adjusting the setting

Non-Dominant

Permanent Pacemakers When a permanent pacemaker is placed, it is implanted within the subcutaneous tissue over the pectoralis muscle on the patient's ______-________ side

ROM

Post-Operative Care After insertion of a pacemaker, assist the patient with gentle _________ exercises at least 3 times daily, beginning 24 hours after implantation

c

The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The nurse knows that the client understands the discharge plan when the client a. selects a low-cholesterol diet to control CAD b. states a need for bed rest for 1 week after discharge c. verbalizes safety precautions needed to prevent pacemaker malfunction d. explains signs and symptoms of MI

c

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? a. Reinforcing the pressure dressing as needed b. Encouraging range-of-motion exercises of the involved arm c. Assessing the incision for any redness, swelling, or discharge d. Applying wet-to-dry dressings every 4 hours to the insertion site

Chest X-Ray

Types of Pacemakers After placement of a transvenous pacemaker, what is extremely important to perform to ensure proper placement and ensure that damage to the heart did not occur?

Sling

Types of Pacemakers After the placement of a transvenous pacemaker, ensure that the patient lies still or limits movement. Extreme movement of the arm can cause movement of the catheter and cause perforation. Often, the patient will have their arm placed in a _________ to reduce movement

Transcutaneous Pacemaker

Types of Pacemakers External device. The pads placed on the chest are the avenue that the energy goes through. It is known as a single chamber pacemaker, meaning that it functions to affect the ventricle. Requires a lot more energy because it has to go through skin, muscle, and bone

Perforation

Types of Pacemakers Placement of a transvenous pacemaker needs extreme consideration. If proper care is not taken while placing, _____________ of the heart tissue can occur

Transvenous Pacemakers

Types of Pacemakers These types of pacemakers are inserted into the venous system through a central line catheter site using specialty pacing wires and delivering the stimulus via electrodes that are in direct contact with the heart tissue itself

Pads

Types of Pacemakers Transcutaneous pacemakers deliver the pacing stimulus to the heart through the chest wall via two large adhesive _________

Breast

Types of Pacemakers With transcutaneous pacemakers, special considerations should be made for women. It is important to lift the ________ and place the pad underneath, or else the pacemaker will not work properly

Spike

When looking at a cardiac monitor strip in a patient with a pacemaker, you must be sure that you see a _________. This means there has been successful capture and that there are no abnormal beats. If all you see is a __________ and no QRS wave, this indicates the patient is not perfusing and needs immediate attention

a e

When teaching a client about self-care following placement of a new permanent pacemaker to the left upper chest, the nurse should include which information? Select all that apply a. take and record daily pulse rate b. avoid air travel because of airport security alarms c. immobilize the affected arm for 4-6 weeks d. avoid using a microwave oven e. avoid lifting anything heavier than 3 lb.