Prepared by: Judith Angelica Lappay Maria Lourdes Luzuriaga Jenelyn Mallillin Marineth Kaye Paguirigan

Presented to: Mr. Eladio Martin Gumabay, RN, MSN

or a QRS complex indicating ventricular depolarization. a spike (straight vertical line) is seen on the monitor or electrocardiogram strip. . Before or following cardiac surgery c. Tachyarrhythmias a. If the electrode is in the ventricle. 3. 2. The spike should be followed by a P wave indicating atrial depolarization.ARTIFICIAL PACEMAKER  Definition: An artificial cardiac pacemaker is an electronic device that delivers direct stimulation to theheart. Sick sinus syndrome 2. the spike is in front of the QRS complex. Supraventricular b. b. the chamber.  Clinical Indications: 1. A large electrode patch is placed on the chest and back. A synchronous or demand pacemaker senses the client·s rhythm and paces only if the client·s intrinsic rate falls below the set pacemaker rate. Symptomatic bradyarrhythmias a. the spike is before the P wave. Asynchronous or fixed rate paces at a preset rate regardless of the client·s intrinsic rhythm. Sinoatrial arrest c. Noninvasive temporary pacing a.  Temporary Pacemakers 1. Following acute MI.  Spikes: 1. Second degree heart block b. Complete heart block 3. arrhythmias and conduction defects b. 4. During coronary arteriography d. the spike is before the P wave and the QRS complex. Wash the skin with soap and water before applying electrodes. Noninvasive temporary pacing is used as an emergency measure or when a client is being transported and the risk of bradydysrhythmia exists. or captured. 3. Sinoatrial bradyarrhythmias b. this pattern is referred to as ´captureµ indicating that the pacemaker successfully depolarized. causing electrical depolarization and cardiac contraction. Prophylaxis a. If the electrode is in the atrium and the ventricle. Overdrive pacing suppresses the underlying rhythm in tachydysrhythmias so that the sinus node will regain control of the heart. Before permanent pacing 4. Heart block a. 2. c. Ventricular ARTIFICIAL PACEMAKER THERAPY  Settings: 1. if the electrode is in the atrium.  Significance: The pacemaker initiates and maintains the heart rate when the natural pacemakers of the heart are unable to do so. When a pacing stimulus is delivered to the heart.

Keep dressing dry. A permanent pacemaker is programmed when inserted and can be reprogrammed if necessary by noninvasive transmission from an external programmer to the implanted generator. Pacemaker function can be checked in the physician·s office or clinic by a pacemaker interrogater/programmer or from home using telephone transmitter devices. 3. femoral. Place the anterior electrode between V2 and V5 positions over the heart. the lead wires are threaded loosely on the epicardial surface of the heart after cardiac surgery. Monitor cardiac rhythm continuously. and cover with nonconductive tape.  Permanent pacemakers 1. or subclavian vein into the right atrium for atrial pacing or through the right ventricle and is positioned in contact with the endocardium. Ground all electrical equipment using a three-pronged plug. displace breast tissue and place under the breast. jugular. . f. c. Do not take the pulse or BP on the left side. with lead wires placed in the atrium and right ventricle.d. Ensure that electrodes are in good contact with the skin. Wear gloves when handling exposed wires. or may be dual chambered. d. g. 7. e. h. avoiding placement over bone. or are designed to be recharged externally. c. Use only inspected and approved equipment. Monitor vital signs. the results will not be accurate because of the muscle twitching and electrical current. 3. rather. Pacemakers are powered by a lithium battery that has an average life span of 10 years. b. d. Place the posterior electrode between the spine and left scapula behind the heart. Monitor pacemaker insertion site. e. Pulse generator is internal and surgically implanted in a subcutaneous pocket under the clavicle or abdominal wall. i. Pacing lead wire is placed through antecubital. Transvenous invasive temporary pacing a. e. 4. the heart rate then can be transmitted to the clinic. Restrict client movement to prevent lead wire displacement. The client may be provided with a device that is placed over the pacemaker battery generator with an attachment to the telephone. 5. 2. Do not shave the hair or apply alcohol or tincture to the skin. The leads are passed transvenously via the cephalic or subclaavian vein to the endocardium on the right side of the heart. b. Permanent pacemakers may be single chambered in which the lead wire is placed in the chamber to be paced. Do not place the anterior electrode over female breast tissue. are nuclear powered with a life span of 20 years or longer. Reducing the risk of microshock a. 6. Insulate the exposed portion of wires with plastic or rubber material (fingers of rubber gloves) when wires are not attached to the pulse generator. 2. Epicardial invasive temporary pacing: applied by using a transthoracic approach. 4.

COMPLICATIONS OF PACEMAKER USE a. swelling of the ankles or legs. Assess cardiac output and hemodynamic stability c.g. diaphragmatic or skeletal muscle stimulation Cardiac tamponade from bleeding Dislodgment of the pacing electrode Improper pacemaker functioning NOTE in patient chart/record: i. Instruct the clients that most electrical appliances can be used without any interference with the functioning of the pacemaker. i. Inform all health care providers that a pacemaker has been inserted. Report signs of dizziness. however. h. Local infection Bleeding and hematoma Hemothorax Ventricular ectopy and tachycardia Movement or dislocation of the lead placed transvenously (perforation of myocardium) Phrenic nerve. iii. Assess appearance or increased frequency of dysrhythmia d. Model of pacemaker ii. e. i. and duration between atrial and ventricular impulses (AV delay) PACEMAKERS: CLIENT EDUCATION a. b. Assess incision site and observe for bleeding. Date and time of insertion iv. Keep a pacemaker identification card in the wallet and obtain and wear a Medic-Alert bracelet. . or drainage from the insertion site. f. Location of pulse generator v. Emphasize the importance of follow-up with the physician. and to maintain a diary of pulse rates. swelling. Avoid contact sports. redness. pacemaker setting noted and compared with the ECG recordings. or shortness of breath. advise the client not to operate electrical appliances directly over the pacemaker site. Type of generator iii. Instruct the client in the sign of battery failure and when to notify the physician. Instruct the client about the methods of monitoring the function of the device. o. l. d. c. j. energy output[m/A]. h. Instruct the client to inform airport security that he or she has a pacemaker because the pacemaker may set off the security detector. hematoma formation or infection e. c. Stimulation threshold vi. Instruct the client to report any fever. e. chest pain. NURSING PROCESS: THE PATIENT WITH A PACEMAKER Assessment: a. Instruct the client about the pacemaker. g. Observe for potential sources of electrical hazards. m. ALL electrical equipment used in the vicinity of the patient should be GROUNDED. Instruct the client that if any unusual feelings occur when near any electrical devices to move 5 to 10 feet away and check the pulse. b. Monitor heart rate and rhythm. g. including the programmed rate. Instruct the client in how to take the pulse. Wear loose fitting clothes. Avoid transmitter towers and antitheft devices in stores. to take the pulse daily. Rate. weakness or fatigue. k. Pacemaker settings (e. b. TEMPORARY PACEMAKER: i. n. Assess electrical interference and development of micro shock. d. ii. f.

b. History of adherence to the therapeutic regimen should be identified. Exposed wires must be carefully covered with nonconductive material. Evaluation: Expected patient outcomes 1. Risk for infection related to pacemaker lead or generation insertion. Identifies when to seek medical attention. Adheres to monitoring schedule. Assess for anxiety ii. Has WBC count within normal range(5. Responds appropriately when queried about the signs and symptoms of infection. Diagnosis: a. 2. Educate to assist patient cope with changes that occur with pacemaker treatment. c. c. Deficient knowledge regarding self-care program. Promoting home and community-based care Teaching patients self-care a. Assess level of knowledge and learning needs of the patient and the family. Change dressing regularly b. Nurses often need to include home caregivers in the teaching and provide printed materials for use by patient and caregiver. Measures and records pulse rate at regular intervals. then assist the patient to identify realistic goals and to develop a plan to attain those goals.000-10. . c. Priorities for learning are established with the patient and caregiver. d. b. Inspect insertion site for redness. PERMANENT PACEMAKER: i. Promoting effective coping a. Teach patient easy-to-use stress reduction techniques to facilitate coping. Has normal temperature. b. and how the patient responded to that emotion. those emotional response to the change. Remains free of infection a. 3. effective coping and maintenance of pacemaker functioning. b. avoiding infection and sources of electromagnetic interference. Ensure with biomedical engineer or electrician an electrically safe environment. c. c. b. soreness or any unusual drainage. iv. Reassure patient that the responses are normal. Increased in temperature and change in wound appearance should be reported to the physician. Experience no abrupt changes in pulse rate or rhythm. Nursing Intervention: Preventing infection a. Exhibits no redness or swelling of pacemaker insertion site. Major goals for the patient may include absence of infection. Teach importance of periodic pacemaker monitoring. Help patient identify perceived changes. swelling. adherence to self-care program. e. Nurse must recognize the patients emotional state and assist patient to explore his/her feelings. v. Maintains pacemaker function a. Describes appropriate methods to avoid electromagnetic interference.000/mm3) c. b.f. iii. Planning: a. d. Risk for ineffective coping. Adheres to self-care program a. promoting safety.