Pacemakers

Question 1

Transcutaneous Pacemaker

Answer 1

External gelled pads are places on chest and attached to pulse generator
Can be used to defibrillate or as a pacer
Electrical charge delivered through skin

Question 2

Transvenous Pacemaker

Answer 2

A lead wire is placed through the venous access to either the atrium or ventricle and attached to an external pulse generator

Question 3

A pulse generator must have a …

Answer 3

rate, sensitivity, and milliamps

Question 4

Permanent Pacemaker

Answer 4

Pulse generator implanted under skin with lead wire passed into atria and/or ventricle via venous access

Question 5

What are the methods of pacing

Answer 5

Can be used to stimulate atria, ventricles or both
Atrial pacing is used to mimic normal conduction and produces atrial kick
Ventricular pacing stimulates ventricular contraction
Dual chamber pacing stimulates both atria and ventricle

Question 6

What is the set rate

Answer 6

Number of impulses/min to produce adequate CO

Question 7

What is the demand mode

Answer 7

Will generate a beat only if patient’s own intrinsic rate drops below pacer rate

Question 8

What is the Asynchronous mode

Answer 8

Paces the heart at a set rate, doesn’t respond to patient’s own intrinsic rate

Question 9

What is Sensitivity

Answer 9

Ability of the pacemaker to sense pt’s own intrinsic beat so there is no competition between pacemaker and pt’s heart rate.

Question 10

Post-op care/teaching

Answer 10

Assess for bleeding, hematoma or infection
Pt should be quiet in bed, not moving the left arm much
May have to wear a sling to immobilize the left arm
No lifting more than 10lbs
Monitor for dysrhythmias or pacer failure for first 24hrs
Avoid magnets of any kind (MRI, cell phones close to PM)
Will alarm in airport - carry a card

Question 11

What are the three pacemaker malfunctions

Answer 11

Failure to pace
Failure to capture
Failure to sense
Failure to capture and sense

Question 12

Explain failure to pace and what are the causes

Answer 12

PM does not initiate an electrical impulse when it is supposed to.
Causes:
Generator/Battery problem 
Fractured wire
Loose of connection

Question 13

Explain failure to capture and what are the causes

Answer 13

Pacer spike but no depolarization (no P-wave or QRS)
Cause:
Milliamp too low 
Wire broken 
Displaced wire

Question 14

What is a nursing intervention and the patient has a failure to capture d/t a displaced wire?

Answer 14

Turn patient to the left side to facilitate contact of pacing wire with the endocardium and septum

Question 15

Explain failure to sense and the causes?

Answer 15

Pacer doesn’t sense the patient intrinsic rhythm and initiates an impulse
Causes:
May be caused by lead displacement

Question 16

What does the first letter in a PM code stand for

Answer 16

Pacing:
A = atria is paced
V= ventricle is paced
D= Both are paced
0= none are paced

Question 17

What does the second letter in a PM code stand for

Answer 17

Sensing
A = atria
V= ventricle 
D= Both
0= none

Question 18

What does the third letter in a PM code stand for

Answer 18

Response to sensing
T= Triggered (triggers pacing in response to intrinsic beat)
I = Inhibited (won’t fire unless pt’s rate drops below paced rate
D = Dual (T+I)
0 = Asynchronous pacing (no respond to pt’s intrinsic rate, paces the heart at a set rate)