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Objectives
By the end of this lecture you will be able
to:
Define pacemaker
Differentiate types of pacemaker
List function of pacemaker
Assist and monitor pt under going pacing
Identifying pt’s educational needs
Definition of cardiac pacing Out line
An electric device Clinical Indication Definition of cardiac pacing
that delivers 1. Symptomatic Clinical Indication
direct electrical bradycardia
Symptomatic heart Pacemaker design
stimulation to 2.
block
stimulate the Pacemaker function
2nd degree heart
myocardium to block Types of pacing
depolarize, 3rd or complete heart
initiating a
block
Nursing diagnosis
mechanical Bifasicular or Nursing intervention
contraction. transfasicular bundle
branch blocks. Pt’s education
3. Prophylaxis
Pacemaker Design Pacemaker Design: Pulse generator
Pacemaker lead Permanent pacemaker Temporary pacing
1. Single chamber Generator is system
encapsulated in a metal generator is externally
(unipolar) pacemaker can, to protect the contained in a small box
Lead placed in atrium or generator from
ventricle electromagnetic
Transcutanus external
interference
Produce large spic on the ECG pacing system house the
generator in a piece of
Sensing and pacing in the equipment similar to
chamber where the lead is portable ECG monitor.
located
More likely to be affected by
electromechanically interference
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Pacemaker Design
2. Dual-chamber (bipolar) pacemaker
One Lead located in the atrium and one in the ventricle
Sensing and pacing in both chambers mimicking the
normal heart function
Produce in visible spic in the ECG
Less affected by electromechanical interference.
Pacing function Pacemaker function
Atrial pacing: Ventricle pacing :
1. Pacing function
stimulation of RT stimulation of RT or LT
atrium produce spic ventricle produce a 2. Sensing function
on ECG preceding P spic on ECG preceding 3. Capture function
wave QRS complex.
Sensing function Pacing function
Sensing :
AVpacing:
Ability of the cardiac pace maker to see
direct stimulation of RT atrium and either
intrinsic cardiac activity when it occurs.
ventricles mimic normal heart conduction
Demand:
pacing stimulation delivered only if the
heart rate falls below the preset limit.
Fixed:
no ability to sense. constantly delivers the
preset stimulus at preset rate.
Triggered:
delivers stimuli in response to (sensing)
cardiac event.
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Capture function
Pacing types
Permanent Capture:
Ability of the pacemaker to generate a
Temporary
response from the heart (contraction) after
Biventricular electrical stimulation.
1. Electrical capture :
indicated by P or QRS following and
corresponding to a pacemaker spike.
2. Mechanical capture:
palpable pulse corresponding to the
electrical event.
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Types of pacing
Types of pacing
2. Temporary pacemaker
1. Permanent pacemaker
Placed during emergencies Used to treat chronic heart condition
Indicated for pts’ high degree heart Surgically placed transvenuosly under
block or unstable bradycardia local anesthesia
Can be placed transvenosly, Pulse generator placed in a pocket
epicardially,transcutanusly or subcutaneously ,can be adjusted
transthorasicly externally
Types of pacing
Complication
3. Biventricular pacemaker
Movement and dislocation of the lead
Used in sever heart failure
Injury
Utilize three leads in right
Bleeding and hematoma atrium, right ventricle and
Ventricular ectopy or VT from wall left ventricle to coordinate
stimulation
ventricular coordination
Infection
and improve cardiac
Cardiac tamponad out put
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Nursing intervention Nursing diagnosis
1. Maintain adequate 2. Avoid injury Decreased cardiac output related to
cardiac output Obtain chest x-ray potential pacemaker mal function
Record information after to check lead wire Risk for injury related to peumothorax
insertion pacemaker model position
,mode, program setting, pt’s Impaired physical mobility related to
Monitor for sign and
rhythm
symptom of
restriction of movement.
Attach ECG for continues Acute pain related to surgical incision or
monitoring hemothorax
Analyze rhythm strips as per Monitor for sign and external pacing stimuli.
protocol symptom of Disturbed body image related to
Monitor vital signs pneumothorax pacemaker implementation.
Monitor urine output Evaluate evidence for
Observe for dysrhythmia bleeding
Nursing intervention Nursing intervention
4. Provide electrically 5. Be aware of hazards in the 3. Monitor for evidence of lead
safe environment facility that can interfere
Protect exposed pacemaker and cause failure
migration and perforation of
parts of electrode Avoid use of electrical razor heart
leads with rubber Avoid direct placement of Observe for muscle twitching
Wear rubber
gloves when
defibrillator paddles over the and hiccups
generator, should be placed
touching a 4-5 inches away. Evaluate chest pain
temporary pacing
lead
Pt’s with permanent Auscultate foe friction rub
pacemaker should never
exposed to MRI because it Observe for signs of cardiac
may alter and erase the tamponade
program memory.
Caution must be used if pt will
receive radiation therapy. / 2008F.ABUDAYAH 21
Patient education
Nursing intervention
1. Anatomy and physiology of the heart
2. Pacemaker function 6. Prevent accidental 7. Preventing infection
pacemaker Take temp every
3. Activity malfunctions
4hrs
Use external plastic Observe for sign and
Specific instruction include covering over external symptoms of
Not to lift items over 1.4kg or perform difficult arm generator all times infection
maneuver. Secure temporary pace
Clean incision site
Avoid excessive stretching or bending excessive. maker over pt’s chest with sterile technique
Avoid contact sport,tennis,gulfing until advised by doctor. or wrist never hang it Monitor vein which
Sexual activity can be resumed when desired over iv pole pacing placed in for
Place a sign over pt's phlipaitis
bed alerting personnel Administer antibiotic
to the presence of
as ordered.
pacemaker.
Evaluate
transecutanuse pacing
every 2 hr
Monitor for electrolyte
imbalances, hypoxia
and myocardial
infarction.
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Patient education Patient education
4. Pacemaker failure
5. Electromagnetic interference
Teach pt to check own pulse
Caution pt that EMI could interfere with pacemaker
function. at least weekly for 1 min
Explain that high energy radar, TV and radio Report slowing on the pulse
transmetters,MRI,large motors may affect the less or greater than the setting rate
pacemaker function.
Report sign and symptom as palpitation ,fatigue
Teach pt to move 4-6 m away from source and
,dizziness ,prolonged hiccups
check pulse. it should return to normal.
Wear identification bracelet and carry a pacemaker
identification cared.
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Patient education Patient education
6. Care of pacemaker site. Most pacemaker equipped with internal filters to
Wear loose-fitting prevent interaction with cell phone.
clothes around pacemaker Tell pt that antitheft devices and airport security
Watch sign and symptom alarms may affect pacemaker and trigger security
alarm.
of infection
Household and kitchen appliance will not affect
Keep incision site clean pacemaker.
and dry. not to scrub site
Advise well balanced diet.
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