Exam 1: Chapter 29 - Pacemakers and Implantable Cardioverter/Defibrillators Flashcards
What is a battery-operated device that electrically stimulates the heart when the natural pacemaker of the heart fails to maintain an acceptable rhythm?
Artificial pacemaker
What is a pacer spike?
the vertical line shown on a cardiac monitor or ekg strip that represents the pacing stimulus that is delivered. it should be followed by a P wave (atrial pacing) or QRS complex (ventricular pacing)
What is a monitor for life-threatening changes in cardiac rhythm and automatically delivers an electric or shock directly to the heart in attempt to restore a normal rhythm?
Implantable cardioverter/defibrillator (ICD)
What pacemaker has an energy source provided by an external battery pack?
Temporary pacemaker
What are the 3 types of temporary pacemakers?
- external (transcutaneous)
- epicardial
- endocardial (transvenous)
What pacemaker has pacing energy that is delivered transcutaneously through the thoracic musculature to the heart via 2 electrode patches placed on the skin?
External (transcutaneous) temporary pacemaker
What pacemaker requires a large amount of electricity, can be painful for client, and is used when symptomatic bradycardia is unresponsive to atropine or other medications used to increase HR?
External (transcutaneous) temporary pacemaker
What pacemaker has leads attached directly to the heart during open-heart surgery and wires run externally through the chest incision and can be attached to an external impulse generator if needed?
Epicardial temporary pacemaker
What pacemaker is commonly used during and immediately following open heart surgery?
Epicardial temporary pacemaker
What pacemaker has pacing wires that are threaded through a large central vein (subclavian, jugular, cephalic) and lodged into the wall of right ventricle (ventricular pacing), right atrium (atrial pacing), or both chambers (dual chamber pacing)?
Endocardial (transverse) temporary pacemaker
What pacemaker contains an internal pacing unit, are indicated for chronic or recurrent dysrhythmias due to sinus or atrioventricular (AV) node malfunction and can be programmed to pace the atrial or ventricular chamber, or both?
Permanent pacemaker
What is the fixed rate (asynchronous) pacemaker mode?
fires at a constant rate without regard for the heart’s electrical activity
What is the demand mode (synchronous) pacemaker mode?
detects the hearts electrical impulses and fires at a preset rate only if the heart’s intrinsic rate is below a certain level
- inhibited: pacers activity is inhibited/does not fire
- triggered: pacers activity is triggered/fires when intrinsic activity is sensed
what is the tachydysrhythmia function pacemaker mode?
can overpace a tachydysrhythmia and/or deliver an electrical shock
What electrical device contains an internal generator and is indicated for survivors of sudden cardiac death syndrome, risk for sudden cardiac death, and spontaneous or symptomatic ventricular dysrhythmias?
Implantable cardioverter/defibrillator (ICD)
What temporary pacemaker should the client receive sedation and analgesia when being paced?
External transcutaneous temporary pacemaker
how long will a permanent pacemaker battery last for?
about 10 years
how long does ICD lithium batter last for?
about 9 years
What can hiccups post insertion of pacemaker indicate?
Generator is pacing the diaphragm
What clients are most at risk for thermal burns following transcutaneous pacemaker insertion?
Those who are older, dehydrated, or have had external pacing for an extended period of time
What should be provided to for clients who have a permanent pacemaker or ICD?
ID card with manufacturers name, model number, mode of function, rate parameters, and expected battery life
What is client education to prevent wire dislodgement in pts with permanent pacemaker/ICD?
- wear a sling when out of bed
- do not raise arm above shoulder for 1-2 weeks
What are activity restrictions for pts with permanent pacemakers or ICD
No contact sports or heavy lifting for 2 months
What should you educate pts about electrical activity for those with permanent pacemakers or ICP
Never place items that generate a magnetic field directly over the pacemaker generator like garage door openers, burglar alarms, strong magnets, generators and other power transmitters, and large stereo speakers and airport security wand detectors
Why should pts inform providers and dentists about the pacemaker/ICD?
Some tests like magnetic resonance imaging and therapeutic diathermy (heat therapy) can be contradicted
What are complications for pacemakers and ICD
Infection or hematoma at insertion site, pneumothorax or hemothorax
What are nursing actions for infection or hematoma at insertion site?
- assess site for redness, pain, drainage, or swelling
- administer antibiotics as prescribed
- monitor PT, PTT, CBC
What are nursing actions for pneumothorax or hemothorax?
- assess breath sounds and chest movement
- monitor O2 saturation
- obtain a chest x-ray after the procedure
What can complications of pacemakers be related to?
insufficient pacemaker settings, lead wire placement and function, battery function, myocardial damage, electrolyte imbalance
How are complications related to pacemakers usually detected?
through ECGs
What is the main complication related to pacemakers?
Arrhythmias - related to ventricular irritation from pacemaker electrode
What are nursing actions for arrhythmias related to complication of pacemaker?
- monitor ecg and bp
- administer antiarrythmics as prescribed
- have emergency resuscitation equipment and medications readily available
What is the main complication of ICDs
risk for infection during insertion or battery/lead replacement procedures
What electrical complications occur with ICDs and what has to happen?
Complication due to delivery of inappropriate shocks that can be identified through device interrogation and required reprogramming of the device
