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Body Systems > Implantable and wearable devices > Flashcards

Implantable and wearable devices Flashcards

1
Q

what happens if the SA node fails to work

A

other areas of the conductive tissue will attempt to gain control of the heart creating inconsistent depolarization of the heart, arrhythmias, and decreased CO

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2
Q

How to diagnosis SA node dysfunction

A
  • sinus bradycardia (less then 60 bmp)
  • paroxysmal supra ventricular tachycardias (atrial fibrillation, atrial flutter)
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3
Q

what are the 3 types of temporary pacemakers

A

1) transcutaneous
2) transatrial
3) transvenus

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4
Q

what are temporary pacemakers indicated for

A
  • acute MI
  • post cardiac surgery
  • drug toxicity
  • bridge to permanent pacemaker
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5
Q

what is a permanent pacemaker

A
  • small, lightweight battery operated device
  • wires implanted into the heart
  • device is implanted into the distal left clavicle area
  • sends electrical stimulus directly to the heart muscle
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6
Q

indications for a permanent pacemaker

A

1) SA node dysfunction
2) 2nd degree AV block with symptomatic bradycardia
3) 3rd degree AV block with symptomatic bradycardia, CHF, atrial fibrillation/flutter, or documented periods of asystole greater then 3 secs or escape rates of less then 40 bpm
4) acute anterior MI with either 2nd degree AV block, 3rd degree AV block or severe bundle branch blocks

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7
Q

conditions that might warrant a pacemaker

A

1) syncope
2) Dizziness
3) CHF
4) metal confusions
5) palpatations
6) dyspnea
7) exercise intolerance

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8
Q

pacemaker in the atrium purpose

A

increased the atrial contribution to ventricular filling resulting in an increased CO

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9
Q

pacemaker in the ventrical purpose

A

increases the ventricular rate in presence of a heart block or symptomatic bradycardia

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10
Q

dual chamber pacemaker purpose

A

maintains timing between atrial and ventricular contractions, further increasing CO

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11
Q

fixed pacemaker mode of pacing

A

fires at a specific, preset rate

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12
Q

demand pacemaker mode of pacing

A
  • fired only when the HR is below a present value
  • has both a sensing mechanism and a pacing mechanism
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13
Q

rate-responsive pacemaker mode of pacing

A
  • firing depends on pts level of activity and respiration
  • automatically increases with increased CO
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14
Q

ICD (implantable Cardioverter Defibrillator) what is it?

A
  • delivers a shock to the heart to cardiovert when a fatal arrhythmia is detected
  • quick but painful
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15
Q

what are ICDs indicated for

A

life threatening arrhythmias

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16
Q

what are the PT implications for pts with pacemakers or ICD

A

1) know if the pt is dependent on temporary pacemaker
2) be careful with wires - put the box in a pocket and leads around the back of the neck to keep out of the way

17
Q

Post pacemaker/ ICD implantation precausions

A
  • bedrest for a few hours
  • sling on left arm for 24 hrs
  • use left UE functionally but avoid overhead movement above 90
  • restrict lifting to 5 lbs
  • no driving until cleared by electrophysiologists
18
Q

what is a Holter Monitor?

A
  • an ambulatory electrocardiography device
  • a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more
19
Q

when would a holter monitor be indicated

A

for someone who it would be difficult to identify cardiac arrhythmias in a shorter time period

20
Q

what is a VAD (left ventricular assist device)

A

mechanical pump that takes of the function of the damages ventricle of the heart to restore normal blood flow

21
Q

purpose of the VAD

A

allows people with advanced heart failure to be able to return to a better quality of life

22
Q

what are the 2 types of VAD

A

1) pulsatile
2) axial flow

23
Q

what are the indication for VAD

A

1) bridge to transplant
2) destination therapy

24
Q

criteria for a VAD implant

A
  • at least 2 admissions to the hospital
  • meds not working
  • hyponatremic
  • hypovolemic
  • inotrope dependent
  • EF less then 35%
25
Q

benefits of VAD

A
  • restores CO and BP
  • reduces the work of the LV
  • improves perfusion to all body organs
26
Q

”+++”

A
  • blood flow is moving at over 10 L/min through the pump
  • might be normal for larger pts
  • could be indicative of a clot forming in the pump
27
Q

”—”

A
  • blood flow is moving at less than 2.5 L/min through the pump
  • could be normal for smaller pts
  • could be demonstrating that pt is hypovolemic “dry” and requires a fluid bolus
28
Q

Blood pressure of VAD pts

A

if pt is pulsatile, manual pressure is preferred (systolic 90-100). pts might be more susceptible to orthrostatic hypotension

29
Q

MAP in VAD pts

A

if pt is not pulsatile obtain MAP with manual cuff and doppler (65-85mmHg)

30
Q

pulse in VAD pts

A

may be thready or absent

31
Q

O2 sat in VAD pts

A

hard to obtain due to poor capillary bed pulsatility

32
Q

what is impella

A
  • a small device that is deployed endovasculary and helps pump blood from the L. ventrical to the aorta
  • temporary
33
Q

indications for an impella

A
  • HF
  • myocarditis
  • off pump CABG
34
Q

contraindications for PT

A
  • VAD malfunction
  • intra-aortic balloon pump
  • open chest
  • active bleeding
  • hemodynamic instability
  • full ventilator support
35
Q

PT after VAD placement

A
  • focus on functional
  • strict sternal precautions (NO MOVING THE TUBE)
  • no percussion or trendenburg
  • post op pain might lead to a kyphotic posture and can compromise RR
  • post op nausea
  • abdominal binder for protection of drive exit site
  • EKG might still pick up native heart contractions
  • HR blunt by Beta blockers
  • CHECK BATTERY LIFE
36
Q

PT after VAD placement - exercise prescription guidelines

A
  • RPE 11-13
  • Stop if symptoms of angina appear, monitor ekg changes, dyspnea greater then 5 , BP drop, O2 sat below parameters
37
Q

Considerations for mobilization with Impella

A

1) is the pt on inotropes or vasopressors?
2) mechanical ventilation/ alert?
3) EKG and vitals ok?
4) able to plan movement and not pull lines?
5) is battery life ok?

Body Systems (4 decks)

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