1. CARE OF PATIENT ON PACEMAKER

2. WHAT IS A PACEMAKER? - A cardiac pacemaker is an electronic device that delivers direct stimulation of the heart

3. What is the purpose of a pacemaker? - the purpose of a pacemaker is to initiate and maintain the heart rate when the hearts natural pacemaker is unable to do so.

4. Pacemaker Function - Cardiac pacing refers to the ability of the pacemaker to stimulate either the atrium, the ventricles, or both heart chambers in sequence and initiate electrical depolarization and cardiac contraction. - Cardiac pacing is evidenced on the ECG by the presence of a spike or pacing artifact

5. Nursing Management I. Maintain cardiac output 1. Record the following information after insertion of the pacemaker 1. Record the following information after insertion of the pacemaker 1.0 pacemaker manufacturer, model, and lead type 1.0 pacemaker manufacturer, model, and lead type 1.1 operating mode (based on ICHD code) 1.1 operating mode (based on ICHD code)

6. 1.2 programmed settings: lower rate limit; upper rate limit; AV delay; pacing threshold 1.2 programmed settings: lower rate limit; upper rate limit; AV delay; pacing threshold

7. 2.Attach ECG electrodes for continuous monitoring of heart rate and rhythm 3.Monitor vital signs every 15 minutes until stable; then as directed. 4.Monitor urine output and level of consciousness 5. Observe for the presence of dysrhyhtmias 6. Obtain 12-lead ECG daily as directed

8. II. Avoiding injury 1. chest x-ray 2. monitor for signs/symptoms of hemothorax or pneumothorax 3. evaluate continually for bleeding 4. monitor for evidence of lead migration and perforation of heart 5. provide an electrically safe environment for patient

9. 6.Be aware of hazards in the hospital environment that can interfere with pacemaker function or cause pacemaker failure and/ or permanent pacemaker damage. 7.Prevent possible accidental pacemaker malfunction 8.Monitor for electrolyte imbalances, hypoxia, and myocardial ischemia

10. III. Preventing infection 1. take temperature every 4 hours; report elevation 2. observe incision site for s/s of local infection 3. be alert to manifestation of bacteremea 4. clean incision site using sterile technique

11. 5. monitor vein for evidence of phlebitis 6. evaluate patients complaints of increasing tenderness and discomfort on incision site 7. Administer antibiotic therapy as prescribed

12. IV. Relieving anxiety 1. Explain procedures, treatments and answer the patients questions with concise explanation 2. Encourage patient to use coping mechanisms to overcome anxiety 3. Monitor for unwarranted fears expressed by the patient and provide explanation to alleviate fear 4. Encourage patient to accept responsibility of care

13. V. Minimizing the effect of immobility 1. bed rest for 24 to 48 hours and immobilization of extremity nearest to permanent or temporary pacemaker lead implant (allows stabilization of leads in the heart and prevent dislodgement) 2. Promote pulmonary function 3. Promote venous return and prevent stasis

14. 4. restrict movement of the affected extremity 5. Assist patients with activity of daily livings as appropriate.

15. VI Relieving pain 1. Prepare patient for discomfort that maybe experienced after pacemaker implant or initiation of transcutaneous pacing. 2. Administer analgesic as prescribed. 3. Offer back rubs to promote relaxation.

16. 4. Provide patient with diversional activities. 5. Evaluate effectiveness of pain-relieving modalities.

17. VII. Maintaining a Positive Body Image 1. Encourage the patient to express concerns regarding self-image and pacer implants. 2. Reassure pt. that sexual activity and modes of dressing will not altered by pacemaker implantation.

18. 3.Offer the pt. the opportunity to talk to others who have had a pacemaker implantation. 4.Encourage spouse of pt. or significant other to discuss concerns of self image with the patient.

19. VIII. Health teachings…. 1. Teach your client on self care. 1. Teach your client on self care. 2. Promote safety. 2. Promote safety. 3. Importance of periodic device monitoring 3. Importance of periodic device monitoring 4. Avoiding infection. 4. Avoiding infection. 5. Avoiding EMI 5. Avoiding EMI 6. Share information about activities that are safe and those that may be dangerous. 6. Share information about activities that are safe and those that may be dangerous.