Exam 1 - Pacemakers

what are pacemakers for?

what are pacemakers for?

o   Help control abnormal heart rhythms with low-electrical pulses to prompt heart to beat at normal rate

what are the indications for pacemakers?

implantable cardioverter/defibrillator

pacemers

who would benefit from an implantable cardioverter/defibrillator?

-pt’s with ventricular tachydysrhythmias who are at risk of needing D-FIB

§  MI with left ventricular dysfunction

§  For pts who survive sudden cardiac death / ventricular dysrhythmias

who would benefit from a pacemaker?

pts with:

§  Symptomatic bradycardia

§  Complete heart block

§  Sick sinus syndrome

§  Cardiac arrest

§  Asystole

§  Atrial tachydysrhythmias

what is an on demand pacemaker?

o   will deliver electricity when the HR falls below a predetermined rate

what is a fixed pacemaker?

o   will deliver electricity at a fixed rate (less common)

what is expected with pacemakers?

§  PACER SPIKES

• shows when electricity is being sent to the heart

what are the different types of pacemaker malfunctions

o   Failure To Sense

o   Failure To Capture

o   Failure To Pace

what is failure to sense malfunction?

·      Doesn’t sense pt HR

·      Causes inappropriate/random firing

what is failure to capture malfunction?

§  due to leads not connected appropriately

§  Electricity is not caught by the heart

§  Leads to bradycardia or asystole

what is failure to pace malfunction?

§  battery issue

§  Pacemaker is not sending electricity

what are the pacemaker complications?

o   Infection- Endocarditis

o   Hematoma Formation

o   Pneumothorax

o   Atrial Or Ventricular Septum Perforation

o   Lead Misplacement

o   Hiccups

why would a pt with a pacemaker have hiccups?

pacemaker is sitting low in the heart – near the diaphragm (tickling the diaphragm)

what is the pt teaching for a pacemaker?

regular pacemaker function checks

report S/S of infection at site

keep dry for 4 days after implantred

avoid lifting on pacemaker side

Avoid close proximity to high output generators

monitor pulse

report HR drops below predetermined rates

wear medical bracelet or device

carry pacemaker info

carry current list of drugs

NO MRI’s unless ok by DR

Microwave use is OK

Travel is ok (let TSA know no wand over pacemaker)

what are the types of pacemakers?

transcutaneous

epicardial

endocardial (transvenous)

what is a transcutaneous pacemaker?

-fully external

-uses pads

-temp

what is trancutaneous pacemaker for?

symptomatic bradycardia when pt is unresponsive to atropine

what are the S/S following a transcutaneous pacemaker use?

fatigue

SOB

chest pain

what is an epicardial pacemaker?

pulse generator outside of the body

-the leads are threaded thru the chest directly to the heart

who benefits from an epicardial pacemaker?

pts with open heart sx

-temp

what is an endocardial pacemaker ?

pulse generator under skin/muscle

-wires threaded thru a large vein and lodged into the wall of the heart

-permanent (change pulse generator as needed)

-can be used also as defribrillator