Pacemaker/CABG/Implantable Cardio-Defibrillator/Valve replacement Flashcards
In what conditions are pacemakers used?
Symptomatic sinus bradycardia and complete heart block.
How is a PPM (permanent pacemaker) implanted?
Cardiac cath unit
Local anesthesia and conscious sedation.
Guide through vein into the heart, leads are placed thought the heart.
What are important pre-procedure nursing actions for PPM?
Consent
Skin prep
CBC
NPO prior to sx
12 lead EKG on chart
Antibiotic prophylaxis
What are some PPM complications?
Bleeding
Infection
Hiccups
Displacement of lead
Pacemaker malfunction
Cardiac tamponad
What is important for a PT to do regarding his arm and a newly inserted Pacemaker?
NOT to move arm above head for ~4weeks.
What is important post-procedure and discharge instructions for the PT will a PM?
Teach signs and symptoms of PM failure
(chest pain, tachycardia, fever)
Teach to monitor HR rhythm by pulse
Carry ID card make and model/Alert bracelet
No lifting > 10 lbs
Stay away from electrical risks
Define the following PM terms. Pace Failure to pace Capture Failure to capture Sense Failure to sense
Pace - sends out signal to fire
Failure to face - fails to deliver amount of BPM/impulse
Capture - depolarization (contraction) following spike
Failure to capture - spike generated but no QRS (ventricle didn’t pump)
Sense - ability of pacemaker to sense heart’s rhythm and know when to send impulse
Failure to sense - PM fails to recognize PT’s electric activity and fires when it shouldn’t
What indications for an ICD? What makes a PT NOT a candidate?
Sustained V-Tach, V-Fib
EF < 35%
Not a candidate if PT has cardiac infection
(needs to be treated first)
What are important teaching points of an ICD?
Sit or lie down if about to receiving shock
Encourage family to learn CPR
No driving ~4-6 weeks
Learn s and s’s of impending shock delivery
Carry ID
What is pre-op teaching for a PT about to undergo a CABG?
C and DB
Splint w/ pillow
Incentive spirometry
ROM exercises
Chest tube
Foley
M. Ventilation
Pain where vein/artery is taken (mamilary artery is a good choice for women)
What is the purpose of cardiopulmonary bypass during open heart sx?
What temperature is the blood cooled down too?
Oxygenates and circulates blood for you
82.6 F
What is treatment of choice for prosthetic valve endocarditis?
IV antibiotics and valve replacement
What is an advantage of mechanical valves?
Better for younger PT’s because they last longer
What criteria makes an appropriate candidate for heart transplant?
< 1 year to live
< 65 years old
End stage HF that is refractory to therapy
