Page 211 - Critical Care Nursing Demystified

196 CRITICAL CARE NURSING DeMYSTIFIED

electrode is placed. A is the atrial chamber, V is ventricular, D is both atrial and
ventricular (dual-chamber pacer), and S is a single chamber that is paced.
The second letter tells which chamber is sensing the patient’s own native
rhythm with the same letter corresponding to the chamber paced. The third
letter refers to what the pacer’s response would be to a patient’s own native
activity. The T means the pacer would trigger on top of the patient’s own activ-
ity. This would be used if the patient had a complete AV block. It would mean
the pacer would be inhibited if the patient’s own rate came in on top of the
paced beat. So a VVI pacemaker is one that would pace the ventricles, and if
the patient’s own QRS occurred, it would sense it and inhibit the pacemaker
from firing.
Rate modulation is signified by the fourth letter, referring to a pacer that can
increase and decrease the heart rate according to demand. So if a patient needs
an increased heart rate due to activity, this pacer would increase the rate if the
patient walks a set of stairs. The last position or fifth refers to multiple pacing
sites. An “A” here would refer to sites in both atria and “V” would refer to both
ventricles being paced. This would most commonly be used in pacing to help
with heart failure or biventricular pacing. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Nursing Diagnoses for Paced Patient Expected Outcomes
Decreased cardiac output due to The patient will have NSR or controlled
slow or fast dysrhythmias atrial/fibrillation flutter
The patient will have a stable mental status
Fluid imbalance, more than body The patient will have no signs/symptoms
requirements due to decreased of fluid overload
effectiveness of the heart pump

H ? How to Do It—How to Prepare a

o
w t
H
o
t—
o D
o I
w
Patient for Transcutaneous Pacing
Patient for Trans
1. A ttach monit oring elec tr odes t o the pati e
1. Attach monitoring electrodes to the patient’s chest: one anterior just below the
left of the sternum and one posterior to the left of the thoracic spine.
left of the sternum and one posterior to t
2. C l ip an y ex c e ssiv e b o dy h air ; ha ir will de c
2. Clip any excessive body hair; hair will decrease conduction of electrodes.
3. Connect the electrode cables to the pacing device, usually a defibrillator
3 C h l d b l h
machine with this capacity.