Pacemakers Flashcards
conduction problems are blocks, like
1st or 2nd degree
premature atrial complexes can be what part of the heart?
atria or ventricles. it just means that they come early.
premature atrial complexes in atria are usually caused by (Art also gets irritated)
irritation
premature atrial complexes - how is the rate and rhythm?
rate usually normal. rhtym usually normal just comes early.
premature atrial complexes (PAC) - P waves
comes early, PR interval normal usually. QRS normal.
if irregular rhtym, always
take apical for a full minute
In most cases PACs are not a sign of
heart disease. Common in Cardio myopathy (a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body)
treatment for PAC - lifestyle modifications
No smoking, loose weight if overweight, heart healthy diet, exercise regularly, limit alcoholic drinks to a maximum of 1 drink/day for women and 2 drinks/day for men (varies with individual)
PAC nursing implications - If patient is symptomatic, what is the treatment?
If patient is symptomatic (presyncope, syncope, angina, dyspnea) expect treatment with calcium channel blockers or beta blockers .
if aFib lasts more than a couple of days, we have to put them on (not blockers)
anticoagulants for 2 weeks before we can cardiovert
aFib atrial rate
400 - 600 bmp. ventricular is just irregular, depending on how well the AV node is blocking the extra beats.
big caution with aFib
development of clots
aFib treatment - calcium channel blockers
help slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the ventricles
aFib treatment - digoxin
Digoxin to help slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the ventricles
mitral and tricuspid diseases - what heart rhthym?
atrial flutter
Ventricular Tachycardia
when 3 or more PVCs (premature ventricular contractions) occur in succession at a rate greater than 100 bpm
coronary artery disease - what heart rhtyhm will you see? (CAD is tachy)
coronary artery disease is MOST common with ventricular tachycardia
vfib - less than 3 mm is what type?
fine, the other is coarse
vtach turns into vfib in about (not 5)
3 min
vfib treatment
CPR, precordial thump, defibrillation, medications. Dfib - the faster the better
pulseless electrical activity - PATCH FOR MD
P = Pulmonary embolus.
A = Acidosis
T = Tension pneumothorax. C = Cardiac tamponade
H = hypovolemia***(most common cause of pulseless), hypoxia, hypo or hyper thermia, hypo/hyperkalemia
M = MI
D = drug overdose (digoxin, calcium channel blockers)
2nd degree heart block - 2 types
mobitz type 1, mobitz type 2
2nd degree heart blocks - what happens?
some, but not all atrial impulses are blocked from the ventricles
mobitz type 1
delay at AV node, longer and longer PR interval. eventually you have no QRS
mobitz type 2 (no QRS w/ 2)
conduction delay at the AV node, PR interval long overall, constant for all beats. SUDDEN QRS drop d
mobitz type 1 and 2 treatment and 3rd degree heart block (Mozart is serious)
pacemaker bc it can eventually turn into complete heart block
3rd degree heart block
ALWAYS need a pacemaker. we don’t know if we’re going to have a cardiac output or not. P waves normal, QRS sometimes wide. other times, QRS not there at all. don’t stree their heart.
anyone with a HR under 40 gets
a pacemaker
Hypokalemia (U lay down with T)
Flattened T waves, prominent U wave
hyperkalemia
Tall, pointy T waves
severe hyperkalemia (big kalema severely loves QVC)
Widened QRS complexes
pacemakers can be placed in
atria and ventricle, or one or the other
demand pacemakers
only work if you need them to
failure to pace (spike my pace)
spike on pacemaker right before QRS, a line.
pacemaker problems (failure)
Failure to Pace, failure to sense, failure to capture
failure to capture (can’t capture P, or QRS)
Pacer spike is noted on ECG but not followed by P waves or QRS complexes
failure to sense
Is when the pacemaker doesn’t sense patient’s rhythm and starts an electrical impulse
when to worry with pacemaker***
ALWAYS WORRY IF THE RATE DROPS BELOW THE SET RATE
pacemaker post-operative care - and what to do with arm?
Postoperative care
Monitor incision
Most common complication is electrode displacement
Immobilize arm to allow wires to imbed
ROM to prevent frozen shoulder
pacemaker pt teaching
Check pulse daily
ID card
Avoid microwaves (most are ok now)/MRI’s
Avoid contact sports
signs pacemaker is not working
Presyncope/syncope
Weakness
Arrhythmia, palpitations, tachycardia/bradycardia
Dyspnea
Constant twitching of muscles in chest or abdomen
Frequent hiccups
Angina, chest pain
Confusion, extreme drowsiness
common problems with pacemakers
Battery depletion
Loose or broken wire between heart and pacer
Lead dislodgment or gets pulled out
Electronic circuit failure
Electrolyte imbalance
Electromagnetic interference (generators, medical equipment)
Cyber attack
Change in condition that requires pacemaker reprogramming
ICD is for ppl with (Tachy needs the ICD)
vtach, vfib
ICD can detect
life threatening arrhythmias and then cardioverts, defibrillates and/or paces and records ECG
The newer subcutaneous ICD delivers the energy at the
left sternum from sites near the left axilla
nursing intervention for ICD
ECG assessment
CXR
Nursing assessment
CO and hemodynamic stability
Incision site
Signs of ineffective coping
Level of knowledge and education needs of family and patient
ICD discharge teaching
Postoperative complications
Follow up appointments
Battery life
ICD - Electrical interference issues - cell phones?
Cell/mobile devices (keep at least 6 inches/15 cm away from implantation site
Security systems and held metal detectors (airports)
Medical equipment (MRI, MRA not recommended
Cardiogenic shock - loss of how much volume?
Due to primary cardiac disorder
Caused by inability of heart to contract effectively
Generally occurs with loss of 40% or greater of left ventricular volume
Stroke volume and cardiac output are reduced.
Heart attack as a cause of
cardiogenic shock: Damaged heart muscle results in reduced force of contractions, reduced stroke volume, and reduced cardiac output.
signs of heart attack - BP?
decreased BP, narrow pulse pressure
ICD - lifting and exercising?
No lifting more than 5 pounds
No contact sports, strenuous exercise or swimming, bicycling, bowling, vacuuming (above shoulder activities)
ICD - driving?
No driving for at least one month and up to 6 months if implanted for previous VT, VF
ICD - how far to keep away from Power generators?
Power generators (keep at least 2 feet/0.6 meters away)
ICD - how far to keep headphone devices?
MP3 player headphones devices (keep at least 6 inches/15 cm away from implantation site)
signs of a heart attack - HR?
tachy or bradycardia
heart attack - breathing?
tachypnea
heart attack - skin?
pale, cool, clammy skin, mottled, anxiety, cynatoic
heart attack - pulse?
jugular vein distention, weak or absent peripheral pulse
heart attack - urine?
decreased urine output
