D.Y.

Patil Education Society (Institution Deemed To Be University)

D.Y. Patil College of Nursing, Kolhapur

LESSON PLAN
ON
PERMANENT PACEMAKER
Presented by:
Mrs, Susmita Mark Dhanawade
M.Sc.(N) – I year
Dept. of Medical-Surgical Nursing

Submitted to:
Assoc. Prof. Mr. Amos Talsandekar
Dept. of Medical-Surgical Nursing,

Submitted on:
Programme : M.Sc. in Nursing
Subject : Medical-Surgical Nursing – I
Topic :Permanent Pacemaker
Group : Basic B.Sc.(N) – II year
Teaching method : Lecture-cum-discussion
A.V. Aids :Poster, PowerPoint Presentations, Roller-board, Chalk-board
Student teacher : Mrs.Susmita Mark Dhanawade
Guide :Assoc. Prof. Mr. Amos Talsandekar
Evaluator :Assoc. Prof. Mr. Amos Talsandekar
Venue : Basic B.Sc. (N) classroom,
D.Y. PatilCollegeof Nursing
Date :
Time :
Duration : 45 min

Previous Knowledge of the students : The students have previous knowledge regarding the anatomy and physiology of
Cardiac system.

General objective :At the end of this class, the students will be able to have in depth knowledge about
Permanent Pacemaker.
Specific Objectives:

At the end of this session, the student will be able to

1. Define Permanent Pacemaker.

2. Enlist the indications of pacemaker.
3. Enlist the contra-indication of Pacemaker.
4. Elaborate the typesof Pacemakers.
5. Explain the purpose of Pacemaker.
6. Enlist the complications of Pacemaker.
7. Explain the procedure of Pacemaker.
8. Elaborate the nursing management of Pacemaker.
Bibliography:
1. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical-surgical nursing (12th ed.).
Philadelphia: Lippincott Williams & Wilkins.

2. Sommers m, Johnson s, beery t. DISEASES AND DISORDERS DISEASES AND DISORDERS A Nursing Therapeutics Manual. 3rd ed.
Philadelphia: F. A. Davis Company; 2007.

3. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical-surgical nursing (10th ed.).
Philadelphia: Lippincott Williams & Wilkins.

4. Williams l, hopper p. Understanding medical surgical nursing. 5th ed. Philadelphia: f.a. Davis company; 2011.

5. Harding, Kwong, Roberts, et.al, Lewis's Medical-Surgical Nursing- Assessment and Management of Clinical Problems (11 th edition). Philadelphia:
Elsevier.
Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
1. SELF INTRODUCTION:
0.10 Self-Introduction
Good afternoon, everybody. I Mrs.Susmita Mark Dhanawade, student
2.
of M.Sc. (N).
As a part of my curriculum, I will be engaging your class today.
We are today going to look forward on Permanent Pacemaker.

TOPIC INTRODUCTION: Introduce the Listens Chalk- Can Anyone

Introduce the The SA node is the primary pacemaker and firesthe impulse, which topic Board answer the
Topic then travels across the atria, to the AV node, bundle of HIS, and name of
5.0 Purkinje fibers. natural
If medications alone are ineffective in eradicating or decreasing the pacemaker of
dysrhythmia, certain adjunctive mechanical therapies areavailable. a human
The most common are pacemakers for bradycardiasand tachycardias, heart?
elective cardioversion and defibrillation for acutetachydysrhythmia,
and implantable devices for chronic tachydysrhythmia.
Surgical treatments, although less common, are alsoavailable.
3. DEFINITION:
3.0 Define
A pacemaker is a tiny device (not more than the size of a small
Pacemaker Defines Writing Roller- Can Anyone
matchbox), placed in the chest or abdomen, that sends small electrical
Board Explain the
impulses to the heart muscles for maintaining a suitable heart rate.
Definition?
A permanent pacemaker is totally implanted within the body. The
power source is placed subcutaneously, usually over thepectoral muscle
on the patient’s nondominant side.

The pacing leadsare placed trans venously to the right atrium and/or 1
or bothventricles and attached to the power source.
4. INDICATIONS:
2.0 Enlist the
Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
indications 1. Sinus node dysfunction Enlist Listening Can anyone
2. Acquired Atrioventricular (AV) block list down the
3. Chronic bifascicular block indications?
4. After acute phase of myocardial infarction
5. Neurocardiogenic syncope and hypersensitive carotid sinus
syndrome
6. Post cardiac transplantation
7. Hypertrophic cardiomyopathy
8. Pacing to detect and terminate tachycardia
9. Cardiac resynchronization therapy in patients with severe
systolic heart failure
10. Patients with congenital heart disease

5. TYPES:
5.0 Elaborate the Enlist the
1. PERMANENT PACEMAKER
types Elaborate Listening Chalk- Types of
2. TEMPORARY PACEMAKER Board pacemakers

a) Transvenous pacing

b) Epicardial pacing

c) Transcutaneous pacing

-PEMANENT PACEMAKER:

It is implanted totally with in the body. The power source is implanted

Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
subcutaneously usually over the pectoral muscle on the patient’s non-
dominant site.

-TEMPORARY PACEMAKER-

It has the power source outside the body.

a) Transcutaneous pacing: leads are threaded

transcutaneous to the chambers and attached to the
power source.

b) Epicardial pacing: the pacing leads are attached to

epicardium during heart surgery.

c) Transvenous pacing: source is attached to large

electrodes placed over the anterior and posterior
chest.

6. Explain the PURPOSE: Explain the Listening

purpose purpose
The purpose of pacemaker is to initiate and maintain the heart rate
when heart’s natural pacemaker is unable to do so.

7. Enlist COMPLICATIONS:
the complications Enlist the Reading and Chart Can anyone
1. Hematoma
Compli- writing enlist
cations the Compli-
cations
Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
2. Pneumothorax

3. Failure to sense or capture

4. Mayocardial perforation

5. Arrythmias

8.
15.0 Explain the PROCEDURE:
procedure → You will first receive a sedative to relax and a local
anesthesia to numb the incision site you will be
awake during procedure Explain the Writing Book-let Can anyone
Procedure And enlist
→ Your surgeon will make a smaller incision typically Listening the
Articles?
near Collar bone

→ Lends will be guided through incision of into a

mayor

→ An x-traymachine will help them to guide leads

through your veins to heart

→ Once the leads have reached the heart, they will

attach the electrodes to heart muscle Theother end of
lead is "attached to pulse generatorwhich contains
battery & electrical circuits.
Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
→ After lead & electrodes are in place, surgeon will
implant the generator under your skin near collar
bone.

→ At the end, surgeon will test the pacemaker tomake sure

it’s working properly before closing your incision with
sutures.

NURSING MANAGEMENT:
Elaborate the Elaborate the Listing and Hand-outs Can anyone
Pre-operative care:
nursing nursing writing explain the
→ Explain the procedure, type and technique of
management manage- pre-operative
pacemaker to patient ment care?

→ Explain cost of procedure and hospital stay

→ Psychological:

-Explain the process of pacemaker insertion

-Reassure the patient.

→ Obtain written consent from patient & newest

→ Remove dentures, jewelry and contact lens

→ Clean & share the area

→ Check the vital signs of the patient.

Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
Intra-operative care: Can anyone
→ Check for serology status explain the
intra-operative
→ Start IV line. With 5% dor normal saline care?

→ Check buttery and pulse generator

→ Prepare emergency cart, the defibrillator& jelly

with ecg monitor

→ Set up all the equipment’s for insertion of

pacemaker

→ the nurse should know about pacemaker generator

including power switch indicator light for pacing
and sensing, stimulus output dial, sensitivity dials
and their proper setting

→ Assist doctor step by step, scrub during procedure

when required.

→ Observe vital sign, ECG monitor carefully for Can anyone

arrhythmia and other complication. explain the
post-operative
Post-operative care: care?
→ Receive the patient

→ Give comfortable position.

→ Record pacing of pacemaker.

Sr. Time Specific Content Teacher’s Student’s AV aids Evaluation
no. Objectives Activity Activity
→ Immobilize the affected part and keep in supine
position but allow movement of fingers and
anklejoint

→ Monitor vital signs and level of consciousness

ofpatient

→ Monitor heart rate and rhythm

→ Prevent infection

→ Take ECG& X-ray in frequent interval

→ Watch for complications

9. SUMMARY:
1.0
Now I would like to summarize the topic. So today we have dealt with
the Permanent Pacemaker, Its definition, indication, contraindication,
types, procedure and nursing management.
10. CONCLUSION:
1.0
So here I conclude today’s topic on Permanent Pacemakerwhich is an
important topic in medical-surgical nursing.
I hope today’s class will be helpful to you in your further undertakings.

THANK YOU

ASSIGNMENT:
Write four nursing diagnosis and prepare nursing care plan for a patient showing sign and symptoms of over pacemaker.