Page 214 - Critical Care Nursing Demystified

Chapter 4 CARE OF THE PATIENT WITH CRITICAL CARDIAC RHY THM DISTURBANCE NEEDS 199

Nursing Interventions for Permanent Pacemakers

Assess the site for bleeding and infection teaching the patient to do so as
s/he will have to check the site at home.

Check for a subclavian pulse on the right to determine if circulation was
compromised during the procedure.

Teach the patient to keep the affected arm in a sling and not to move it vig-
orously until the pacer wires have had time to implant.

Have the patient demonstrate taking his or her radial pulse to check for
regular rhythm.

Remind the patient to keep regular checkups to see if the pacer is working
correctly.

Teach the patient the signs/symptoms of decreased cardiac output, so s/he
can seek medical attention early.

Teach the patient to avoid close contact with very strong electromechanical
devices like high-tension wires and magnetic resonance imagers (MRIs) as
their strong interferences can shut off the pacemaker. Home devices are not
really an issue with newer pacers. 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.
Encourage the patient to obtain a medical alert tag to wear to alert health
care providers of the pacer’s presence, especially in a cardiac arrest.

NURSING ALERT

Patients with permanent pacemakers should carry a medical alert card. Nursing staff

should be vigilant not to defibrillate over a permanent pacemaker as the electrical
charge will follow the implanted lead wires and cause damage to the chambers of
the heart at their distal ends!

Implantable Cardiac Defibrillators (ICDs)

What Went Wrong?
An implantable cardiac defibrillators (ICD) is an electrical device that is surgi-
cally placed at about the same anatomic place as a permanent pacemaker. This
device is used when a patient has had past episodes of ventricular fibrillation
uncontrolled by medication and has had an episode of cardiac arrest unrelated
to an MI. ICDs can also be programmed to be pacemakers to stop fast or slow
rhythms. ICDs sense how long the patient’s rhythm stays on the isoelectric line.