Page 212 - Critical Care Nursing Demystified

Chapter 4 CARE OF THE PATIENT WITH CRITICAL CARDIAC RHY THM DISTURBANCE NEEDS 197

4. Administer sedation/analgesics.
5. Turn the power on and select the synchronous (demand) or asynchronous
(fixed) pacing.
6. The pacing rate is usually selected at around 80. Dial this in.

7. Set the pacing current output by slowly increasing the mA (strength) on the ma-
chine at the minimum amount of voltage until you see a spike on the cardiac mon-
itor before the chamber being paced. Set 10% higher as a safety precaution.
8. To ensure proper pacing, a pacer spike needs to immediately precede the
R wave, the QRS is wide and bizarre, almost like a PVC.
9. Document a rhythm strip, the vital signs, sedation used, pacer settings, and how
the patient tolerated the procedure.

Nursing Interventions for Transcutaneous Pacemakers
Prepare the patient for this emergency procedure to decrease anxiety and
provide trust in the health care provider.
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sedation as the external shock can cause uncomfortable muscle contractions.
Prepare the skin for electrode placement by cleaning, clipping hair, and
applying the pads firmly to the anterior and posterior chest. Firm contact
ensures proper capture.
Turn the mA up using only the amount of voltage needed to pace the heart
as this will decrease pain from electrical shock.
Observe the QRS; it will appear wide with a sharp pacer line immediately
before it due to its coming from a source outside the normal conduction
system.
Teach the patient and family that the muscles will twitch with each beat.

Nursing Interventions for Epicardial Pacing

Note that the wires are labeled on the outside dressing once the patient
comes from surgery; there can be atrial, ventricular, and ground wires. If they
are not marked, the nurse could attach them to the wrong ports on the exter-
nal generator box.
Attach the wires to the appropriate ports on the external generator box while
wearing gloves. The nurse needs to be grounded by the gloves or electrical
current can pass through the wires into the heart causing a lethal rhythm.