Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSG 478 > Pacemakers, Defib, cardioversion > Flashcards

Pacemakers, Defib, cardioversion Flashcards

1
Q

Pacemaker

A
  • Battery operated device that stims the heart when the natural PM of the heart is unable to maintain an acceptable rhythm
  • Can be temp or perm
  • Composed of 2 parts, pulse gen houses with the battery and the control center
  • Electrodes connect to the battey to the heart muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Indications for a pacemaker

A
  • Bradycardia (symptomatic)
  • Complete Heart Block (3rd degree)
  • Sick sinus syndrome (Tachy Brady syndrome)
  • Sinus arrest (Long pause between beats)
  • Atrial tachydysrythmias
  • Most common indications for pacemaker are SA node dysfunction and high grade AV block (2nd and 3rd)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does a pacemaker look like on the strip

A
  • Presence of a verticle line before the area where the pacemaker is pacing
  • If it is pacing the atria, there is going to be a spike before the P wave
  • If its pacing the ventricles, there is going to be a spike before the Q wave
  • More than one spike, dual chamber
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of pacemakers: External

A
  • Transcutaneous
  • Pacing energy is delivered through the thoracic musculature to the heart via 2 electrodes placed on the skin
  • Kinda placed like defib pads
  • Uses a large amount of energy, which is painful to pt
  • used when symptomatic bradycardia is present to increase HR
  • Should be used temp

Temp pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of pacemakers: Epicardial

A
  • PM leads are attached directly to the heart during open heart surgery (CABG)
  • Wires run externally through an incision in the chest and can be attached to an external impulse gen if needed
  • Wires are usually kept in until discharge just in case

Temp pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Types of pacemakers: Endocardial

A
  • Transvenous
  • Pacing wires are threaded through a central vein and lodged into the wall of the RA for atrial and RV for ventricular pacing, or both for dual chamber
  • Settings are mA, Sensitivity and Rate

Temp pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Temp pacemakers

A

Purpose is to establish normal hemodynamics that are compromised by a slow or fast HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Transvenous PM: mA

A
  • Milliamps, turn the current down slowly to the point where you lose capture, you want to use the minimal current, increasing it by 2.5 for constant capture with the least necessary power
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Transvenous PM: Sensitivity

A
  • Sensitivity is the threshold where a specific mA level exuded by the P or R wave for the PM to recognize it and fire
  • If sensitivity is set to a high mV threshold the generator might not pace at all because it wont detect the underlying rhythm
  • If the sensitivity is right it will sense an underlying bradycardic rhythm and allow intrinsic beats, the PM will be able to supplement these beats to achieve a good HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Transvenous PM: Rate

A
  • Can be adjusted as needed
  • Goal is to achieve perfusion
  • Set usually at 60-70
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Perm PM

A
  • Contains an internal pacing unit
  • Indicated for pts with chronic or recurrent dysrhythmias due to SA or AV node dysfunction
  • Can be programmed to pass the atrial (A) or ventricular (V) chamber or both (AV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pacemaker Modes: Fixed rate

A
  • Does all the work for you
  • Asynchronous
  • Fires at a constant rate without regard for heart electrical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pacemaker Modes: Demand mode

A
  • Only fires if you become brady
  • Synchronus
  • Detects the hearts electrical impulses and fires at a preset rate when the hearts intrinsic rate is below a certain level . The PM response mode includes
    • Inhibited
    • Triggered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pacemaker Modes: Inhibited

A

Part of Demand mode
* PM activity is inhibited and does not fire
* For example a VVI mode: if there is no QRS detected the PM fires, if there is a QRS it is inhibited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pacemaker Modes: Triggered

A
  • PM activity is triggered/fires when intrinsic activity is sensed
  • Part of demand mode
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pacemaker Modes: Tachydysrhythmia Function

A
  • Can over pace a tachydysrhythmia and/or deliver an electrical shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Five Letter system to identify PM function

A
  1. Chamber placed
  2. Chamber sensed
  3. Response mode
  4. Programmable functions
  5. Tachydysrhythmia functions

Only worry about the first three

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Five Letter system to identify PM function: Chamber placed

A
  • O: None
  • A: Atria
  • V: Ventricle
  • D: Dual (AV)
19
Q

Five Letter system to identify PM function Chamber sensed

A

What chamber the PM is sensing the activity of
* O: None
* A: Atria
* V: Ventricle
* D: Dual (AV)

20
Q

Five Letter system to identify PM function: Response mode

A

O: None
T:Triggered
I: Inhibited
D: Dual

What the pacemaker does

21
Q

DVI (Five Letter system to identify PM function)

A

Dual (Pacing both the atria and ventricle)
Ventricle: sensing the activity of the ventricle only
I: The PM is inhibited with QRS activity , PM does not make an impulse when ventricle is active

22
Q

DDDR pacemaker

A
  • Dual pacing
  • Dual sensing (Atria and ventricle
  • Dual response (Inhibition and triggered)
  • Rate responsive: Pacing rate can adapt to physical activity
23
Q

Most common pacemaker modes

A

DDD
VVI
AAI

24
Q

Ventricular pacing

A
  • There may or may not be atrial activity noted depending on underlying rhythm
  • On strip: Spike but no P wave
  • Frequently, ventricular demand pacing is used in association with a-fib
25
Q

Implantable cardioverter/defibrillator (ICD)

A
  • Monitors for lethal changes in heart rhythms (Vtach, Vfib) and delivers a shock to try and restore a normal rhythm
  • ICD can be programmed to deliver a shock and has pacing capabilities
26
Q

ICD, etiology

A
  • Contains an internal gen
  • Indicated for survivors of sudden cardiac death syndrome, risk for cardiac death and spontaneous symptomatic ventricular dysrhythmias
  • Pts with HF and abnormal LVEF
  • ICD are considered Primary prevention in pts with an EF with less than 35 and CHF
27
Q

A 10% reduction in EF below 45 is associated with

A

39% increased risk of mortality

28
Q

Complications of PM

A
  • Bleeding/hematoma at lead entry site
  • Infection at insertion site
  • Dislocation of lead
  • Hemothorax from puncture of subclavian or mammary during insertion
  • Phrenic nerve stimulation (Forever hiccups)
  • Cardiac tamponade from bleeding
29
Q

Cardiac tamponade

A
  • Compression of heart from fluids collecting in the sac surrounding the heart, putting pressure on the heart and keeps it from filling or ejecting properly
  • Causes a dramatic drop in BP which can be fatal
  • Usually treated by draining the blood
  • Symptoms can include low BP, SOB, lighheadedness
30
Q

PM malfunction: Loss of capture

A
  • Electrical stim isn’t enough to elicit a pace
  • Treated by switching battery or gen
  • Also helped by turning pt to left side
31
Q

PM malfunction: Undersensing

A
  • Sensitivity is set too high, and is unable to detect the depolarization on the heart (Contraction)
  • Atrial or P wave spikes arise regardless if there is depolarization
  • Goes almost on a rhythm because its not communicating with the heart
  • Results in the appearance of too many pacing spikes
32
Q

PM malfunction: Oversensing

A
  • When PM detects electrical signals that aren’t there or it shouldn’t pick up and fires
  • Results in inappropriate inhibition of the pacing stimulus
33
Q

Nursing actions for PM insertion: Temp PM

A
  • Wires and PM box are on pts chest after procedure
  • Do not change the dials on the PM box
  • The wires and box need to be kept dry (No pt showers)
  • If transcutaneous pacing is required, large EKG pacing pads are placed on chest and back, pt might need sedation or analgesia
34
Q

Nursing actions for PM insertion: Perm PM/ICD

A
  • Small incision is made in pec using local anesthetic and IV sedation
  • Device can be reprogrammed externally after procedure
  • Battery last 10 years ish
35
Q

Post Procedure Nursing actions

A
  • Document, model, settings, rhythm strip, VS, patient response
  • Continually check monitor HR
  • Obtain CXR to check lead placement, rule out pneumo or hemo
  • Analgesia as ordered
  • Minimize shoulder movement to allow leads to anchor, provide sling
  • monitor insertion site
  • Assess for hiccups (Phrenic nerve)
  • Transcuteneous pacing (inspect skin, thermal burns)
  • With PPM/ ICD : give pt id card with manufacturer, model, mode, rate, and battery life
36
Q

Patient education PPM, ICD

A
  • Carry ID card
  • Prevent wire dislodgement (Wear sling, don’t raise arm above shoulder for 2 weeks)
  • Take pulse daily, notify provider if HR is lower than PM set rate
  • Report dizziness, fainting, weakness, hiccups, palpitations , SOB
  • If you’re touching someone when ICD delivers a shock, they wont get hurt
  • Don’t lift heavy for 2 mo
  • Never place items that generate magnetic fields over the PM (Garage door openers, strong magnets, MRI)
  • INform providers of PM/ICD, some test are contraindicated
  • Inform airport security as they shouldn’t use the wand over the PM
37
Q

Complications of PM: Infection or hematoma

A
  • Assess the incision site for redness edema, pain or discharge
  • Admin anti bio if ordered
38
Q

Complications of PM: Pneumo or hemo

A
  • Assess for dyspnea, breath sounds, O2 sat
  • Chest Xray should be done post procedure and next day
39
Q

Complications of PM: PM malfunction

A
  • Monitor rate and rhythm, notify provider if changes
40
Q

Complications of ICD: Inappropriate shocks

A
  • Requires device interrogation, probable reprogramming of device
  • Get a shock when they aren’t in vfib/tach
41
Q

Defib

A
  • Async delivery of energy, done at any part of the rhythm, because there isnt a rhythm for these pts
  • Higher charge (360 J)
  • Done for Vfib/tach (Unstable), more emergent

Dont put vasoline on the pads, itll burn pt

42
Q

Cardioversion

A
  • Synchronized delivery of energy to the QRS complex, done during the peak of the R wave
  • Elective procedure
  • Lower energy (50-200 J)
  • Done for A-fib, SVT, V-tach (Stable)
43
Q

Defib and cardioversion safety

A
  • Ensure good contact between the skin and paddles
  • Use a conductive medium and 20-25 pounds of pressure (Not vasoline)
  • Place paddles so they are not touching clothing, bedding, medication patches or oxygen. Do not place paddles over patient’s PM or ICD
  • If cardioverting, SYNCHRONIZER MUST BE ON
  • If defibrillating, SYNCHRONIZER MUST BE OFF
  • Do not charge until you are ready to shock
  • Call “clear” 3 times and ensure no one is in contact with the bed, patient or equipment before shocking

NSG 478 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions