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AcuteBiologicalCrisis.. Skills

AcuteBiologicalCrisis.. Skills

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Published by: chelljynxie on Sep 15, 2009
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11/02/2012

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AcuteBiologicalCrisis
Pacemakers
DialysisPacemakers
Clinical Indications
Symptomatic bradydysrhythmias
Symptomatic heart block Mobitz II second-degree heart block Complete heart block Bifascicular and trifascicular bundle branch blocks
ProphylaxisAfter acute MI: dysrhythmia and conduction defectsBefore or after cardiac surgeryDuring diagnostic testingCardiac catheterizationEPSPercutaneous transluminal coronary angioplasty (PTCA)Stress testingBefore permanent pacing
Tachydysrhythmias; to break rapid rhythm disturbancesSupraventricular tachycardiaVentricular tachycardia
Temporary Pacemaker 
 Non-invasive Pacemaker  Non-invasive – used as an emergency measure or when aclient is being transported and the risk of bradydysrythmia existA large electrode patch is placed in the chest and back Wash the skin with soap and water before applying theelectrodesDo not shave the hair or apply alcohol or tinctures on theskinPlace the posterior electrode between the spine and leftscapula behind the heart avoiding placement over a bonePlace the anterior electrode between V2 and V5 positions over theheartDo not place the anterior electrode over female breast tissue;rather, displace the breast tissue and place under the breastDo not take the pulse or BP on the left side; the result willnot be accurate because of the muscle twitching and electricalcurrentEnsure that electrodes are in good contact with skinIf loss of “capture” occurs, assess the skin contact of theelectrodes and increase the current until capture is regainded
Temporary Pacemaker 
Transvenous invasive temporary pacing
 
 pacing lead wire is placed through anctecubital, femoral, jugular,or subclavian vein into the right atrium fro atrial pacing or throughthe right ventricle and is positioned in contact with theendocardiummonitor cardiac rhythm continuouslyMonitor VSMonitor pacemaker insertion siteRestrict client movement to prevent lead wire displacement
Permanent Pacemaker 
A pulse generator is internal and surgically implanted in a SQ pocketunder the clavicle or abdominal wall
The leads are passed transvenously via the cephalic or subclavian vein tothe endocardium on the right side of the heart
May be single chambered- the lead wire is placed in the chamber to be paced;
Dual chambered- lead wires are placed in the atrium and right ventricle
It is programmed when inserted and can be reprogrammed if necessary bynon-invasive transmission from an external programmer to the implantedgenerator 
They are powered by a lithium battery that has an average life span of 10years; those that are nuclear powered has a life span of 20 years or longer;or are designed to be recharged externally
Pacemaker function can be checked in the physician’s office or clinic by a pacemaker interogater/programmer or from home using telephonetransmission devices
The client may be provided with a device that is placed over the pacemaker battery generator with an attachment to the telephone; the heartrate then can be transmitted to the clinic
Provide client instructionsinstruct client on how to take the pulse; take pulse daily andmaintain a diary of pulse ratewear loose-fitting clothingavoid contact sportsinstruct client to inform airport officials that a pacemaker is presentadvise client not to operate electrical appliances directly over the pacemaker siteavoid transmitter towers and anti-theft devices in storesinstruct client that if any unusual feelings occur when near anyelectrical devices to move 5-10 feet away and check the pulseemphasize the importance of follow-up with the physician
Equipments
Disposable electrode pads
External pacing module
Resuscitative equipment
 
Procedure
Preparatory phaseExplain procedure to patient.Explain sensation of discomfort with external pacing.
Performance phase
Gradually increase milliamp output until a pacing spike and correspondingQRS complex are seen. Palpate pulse to ensure adequate response toelectrical event.
Check pad placement frequently.
Follow-up phase
Check vital signs at least every 15 minutes while continuous pacing isemployed.
Monitor ECG continuously for pacer functioning.
Assure patient that treatment is temporary.
Prepare patient for transvenous or permanent pacemaker insertion asindicated.
Endotracheal Intubation
Clinical Indications
Acute respiratory failure, CNS depression, neuromuscular disease, pulmonary diseases, chest wall injury
Upper airway obstruction (Tumor, inflammation, foreign body, laryngealspasm).
Anticipated upper airway obstruction from edema or soft tissue swellingdue to head and neck trauma, some post operative head and neck  procedures involving the airway, facial or airway burns, decreased level of consciousness (GCS = <8)
Aspiration prophylaxis
Fractured cervical vertebrae with spinal cord injury requiring ventillatoryassistance
Complications of Endotracheal Tubes
Laryngeal or tracheal injurySore throat, hoarse voiceGlottic edemaUlceration or necrosis of tracheal mucosaVocal cord ulceration, granuloma, or polypsVocal cord paralysisPostextubation tracheal stenosisTracheal dilationFormation of tracheal-esophageal fistulaFormation of tracheal-arterial fistulaInnominate artery erosion
Pulmonary infection and sepsis
Dependence on artificial airway

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