May impair the pacemaker stimulation threshold.Ĥ. Check the patient for low blood sugar levels, and use glucocorticoids or sympathomimetics, mineralocorticoids, or anesthetics. Prevents accidental disconnection and dislodgement of lead wires immediately after placement.ģ. Limit movement of extremity involved near the insertion site as ordered. Electric current seeks the path of least resistance, and the potential for stray current to travel through the electrode into the patient’s heart may precipitate ventricular fibrillation.Ģ. Prevents the potential for microshock and accidental electrocution. Avoid touching equipment and the patient at the same time. Ensure that all electrical equipment is grounded. This may indicate “pacemaker syndrome” or failure of the pacer to function which results in decreased perfusion. Monitor the patient for complaints of dizziness, weakness, fatigue, syncope, edema, chest pain, palpitations, pulsations in neck veins, or dyspnea.ĭuring ventricular pacing, AV synchrony may cease and cause a sudden decrease in cardiac output. This may indicate perforation of the pericardial sac and impending or present cardiac tamponade.ħ. Monitor for sudden complaints of chest pain, and auscultate for pericardial friction rub or muffled heart tones. This may indicate pacer lead had dislodged and migrated to the chest wall or diaphragm after perforation of the heart.Ħ. Potential causes are lead dislodgement, battery failure, low, sensitivity, wire fracture, or improper placement of the catheter.ĥ. Monitor for signs of failure to sense the patient’s own rhythm, and correct the problem. Monitor vital signs every 15 minutes until stable repeat every 2 hours or prn.Īssures adequate perfusion and cardiac output.Ĥ. Identifies proper functioning of pacemakers, with appropriate capture and sensing.ģ. Obtain and observe rhythm strip every 4 hours and prn. Pacer electrodes may irritate the ventricle and promote ventricular ectopy.Ģ. Observation for pacemaker malfunction promotes prompt treatment. Monitor ECG for changes in rhythm, rate, and presence of dysrhythmias. The client’s permanent pacemaker will function without complications, with no lead dislodgement or competitive rhythms noted.ġ.The client will be able to adhere to all activity restrictions.The client will be able to recall accurately all instructions given.The client will be free of dysrhythmias and be able to maintain cardiac output within normal limits.The client will be free of dysrhythmias with an adequate cardiac output to perfuse all body organs.Increased peripheral vascular resistance.Decreased cardiac output, stroke volume.Ineffective Tissue Perfusion: Cardiopulmonary, Cerebral.Ineffective Tissue Perfusion Nursing Diagnosis Here are six (6) pacemaker therapy nursing diagnoses and nursing care plans: Nursing care for patients with pacemakers involves the monitoring and prevention of common complications, preventing dislodgement, and educating the patient on the proper use and maintenance of the pacemaker. The electrodes may be unipolar or bipolar, and the proximal end attaches to a pulse generator that is placed in the chest or abdomen. The stimulus of the pacer is produced by a pulse generator and delivered via electrodes or leads that are implanted in the epicardium or endocardium. The function of the pacemaker (or pacer) is to maintain the heart rate when the patient’s own intrinsic system is unable to do so. Pacemakers provide an electrical stimulus to depolarize the heart and cause a contraction to occur at a controlled rate. A pacemaker is an electronic device that provides electrical stimuli to the heart muscle.
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