Case Study: Permanent Pacemaker
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
2. Nursing care includes incision site assessment for three complications:
a.___________________________________________________________________
b.___________________________________________________________________
c.___________________________________________________________________
3. The most common postoperative complication is ____________, which can be prevented by ___________________________.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a.___________________________________________________________________
b.___________________________________________________________________
c.___________________________________________________________________
d.___________________________________________________________________
e.___________________________________________________________________
f.____________________________________________________________________
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a.________________________________________________________________
b.________________________________________________________________
c.________________________________________________________________
Nursing interventions:
a.________________________________________________________________
b.________________________________________________________________
c.________________________________________________________________
Expected outcomes:
a.________________________________________________________________
b.________________________________________________________________
c.________________________________________________________________
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a.________________________________________________________________
b.________________________________________________________________
46 comments:
.
Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
yes this is expected for the type of pacemaker that senses the intrinsic ability of the heart to pace itself, the type of his pacemaker should be on demand pacing which activates the pacemaker only if the patient's heart rate drops below the preset heart rate of the pacemaker
2. Nursing care includes incision site assessment for three complications:
a.infection
b.hematoma formation
c.bleeding
3. The most common postoperative complication is dislodgement of pacing electrode, which can be prevented by activity restriction on the site of implantation.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a.model of pacemaker
b.type of generator
c.date and time of insertion
d.location of pulse generator
e.stimulation threshold
f.pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a.prevention of infection
b.adherence of patient to a self care program
c.patient maintains pacemaker functions
Nursing interventions:
a.monitor incision site for signs of infection; like redness, or swelling, fever, pain, tenderness, color and smell of discharges, and heat
b.teach client about important information about pacemaker,signs of emerging infections, types of situations,appliances and machines that may cause interference to pacemaker,signs or times to seek medical help, and keeping a schedule for monitoring pacemaker function.
c.teach client to monitor and record rate at regular intervals of to ensure proper function, and seek medical help if there will be abrupt changes in pulse rate of rhythm
Expected outcomes:
a.patient remains free of infections and achieves timely wound healing at incision area.
b.patient able to repeat concepts taught to him about self care,and pacemaker care.
c.patient is able to implement scheduled monitoring of pacemaker functions and is able to identify normal against detrimental changes in pacemaker functions
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. signs and symptoms of infection
b.the existing level of knowledge and learning needs of patient and family
c.pacemaker function, heart rate and rhythm, assessment for deviations
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
-yes, for every type of pacemaker chosen to a patient is according to one's heart condition, and it is programmed on minimum heart rate. but when patient's heart rate drops below that set rate, his pacemaker generates an electrical impulse that passes through the lead to the heart muscle which causes the heart muscle to contract, creating a heartbeat
2. Nursing care includes incision site assessment for three complications:
a. local infection
b. bleeding
c. hematoma formation
all at the lead entry sites for temporary pacing, or at the subcutaneous site for permanent generator placement
3. The most common postoperative complication is dislodgement of the pacing electrode, which can be prevented by minimizing patient's activity. with a permanent pacemaker, the patient is instructed to restrict activity on the side of the implantation.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. model of pacemaker
b.type of generator
c. date and time of insertion\
d. location of pulse generator
e. stimulation threshold
f.duration between atrial and venticular impulses
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a. absence of infection
b. adherence to a self-care program
c. effective coping
Nursing interventions:
Preventing infection
-change dressings regularly, inspect the insertion site for redness, swelling, soreness, or any unusual drainage.
Promoting effective coping
-recognize the patient's emotional state and assist the patient to explore his or her feelings;
-help the patient to identify perceived changes and how the patient responded to that emotion;
-teach the patient easy-to-use stress reduction techniques like deep breathing exercises to facilitate coping
Promoting Home and community based care
-teachings include the importance of periodic pacemaker monitoring, promoting safety, avoiding infection, and sources of electromagnetic interference
Expected outcomes:
a. Remains free of infection; has a normal temp and no redness or swelling on pacemaker insertion site
b. adherence to a sel-care program; responds appropriately when queried about the signs and symptoms of infection
c. maintains pacemaker function
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. signs and symptoms of infection (temperature range, wbc count, redness or swelling etc)
b. patient adheres to monitoring schedule, identifies when to seek medical attention(as demonstrated in responses to signs and symptoms)
c. measurements and records of pulse rate at regular intervals and no abrupt changes in pulse rate or rhythm
Rex Kester Bobila
1. Yes, pacemaker are generally set to sense and respond to intrinsic activity of the patient's heart. any occurrence of tachydysrhythmia would activate the antitachycardia pacing, and would stop when the BPM reaches the set limit. in this case 72 beats/minute.
2. a. local infection at the entry site
b. bleeding
c. hematoma
3. complication - dislodgment of the pacing electrode
prevention - minimizing patient activity on the side of the implantation
4. a. model of pacemaker
b. type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation threshold
f. pacer settings.
5. Goal:
a. absence of infection,
b. adherence to a self-care program,
c. Maintenance of pacemaker function
Nursing Intervention
a. Change the dressing regularly and inspects the insertion site for redness, swelling, soreness, or any unusual drainage.
Increase in temperature and wound appearance is reported to the physician.
b. Include home caregivers in the teaching and provide reading materials for use by patient and caregiver. Teaching may include importance of periodic pacemaker monitoring, promoting safety, avoiding infection, and sources of magnetic interference.
Advice the patient to wear loose-fitting clothing around the area of the pacemaker.
c. Instruct the patient to monitor and record pulse rate at regular intervals. And any sudden slowing or increasing pulse rate should be reported immediately to the physician.
adherence to monitoring schedule to the physician or pacemaker clinic, especially during the first month after implantation.
Expected outcome
a. Patient remain free from infection
b. patient appropriate describes methods to avoid electromagnetic interference
patient adheres to monitoring schedule
c. measures and records pulse rate at regular intervals
experiences no abrupt changes in pulse rate or rhythm. and will report to the physician any sudden increase or decrease in pulse rate.
6. Expected outcomes:
a. freedom from infection
b. adherence to a self-care program
c. maintenance of pacemaker function.
Assessment criteria
a. signs and symptoms of infection at incision site
b. level of knowledge and learning needs of the patient and the family and the history of adherence to the therapeutic regimen are identified.
c. examination of the pacemaker spike and its relationship to the surrounding ECG complexes.
Answers:
1. Yes. It is because these pacemakers have their own ability in which they can sense and respond easily to the activity of the heart.If in case the heart rate of the patient drops the pacemaker will respond and will create a heartbeat.
2. The 3 complications are:
1. hematoma
2. Bleeding
3. Infection at the site were it is inserted.
3. dislodgement of the pacing electrode is the most common complication and it is prevented if we explain to the patient the importance of minimizing activities that may aggrvate the insertion site.
4. 6 things that must be included in the patients chart are:
1. model of the pacemaker
2. type of generator
3. date and time the pacemaker is inserted
4. location of pulse generator
5. stimulation threshold
6. pacer setting
5. goals:
1. preventing infection
2. adherence to self-care
3. patient should be educated about the maintenance of the functions of the pacemaker.
Nursing Intervention:
1. always check the incision site for swelling, redness, fever, smell of the discharge.
2. educate the patient about self care,like teaching the patient the importance of the pacemaker and of course the contraindications like cellphones, weldings, etc. teaching also the patient when to seek for medical help.
3. teach patient to monitor rate of the pacemaker and to seek medical attention if abnormalities occurs.
Expected Outcome:
1. if the patient will maintain the site free from local infections healing of the open wound will be faster.
2. the patient will be able to apply the self-care on his own and even at home.
3. the patient will become aware about his situation and will comply to what the doctors will suggest.
6. Assessment Criteria:
1. Signs and symptoms of infection at the insertion site.
2. level of knowledge and learnings of the patient and the family.
3. function of the pacemaker and the donts in having pacemaker.
Baruel, Randy A.
BSN 2009
IV-A
Activity #1
1.Yes. The primary purpose of the pace maker is to produce an electric impulse which the heart, specifically the sinus node, cannot produce by itself. This response of the heart is the inhibited response, meaning that the pacemaker is controlled by the activity of the patient’s heart. And the pacemaker will not function if it senses that the patient’s heart beats above the baseline, which is 72, but will pace if no beats is sensed and/or if the beats sensed is lower than the preset beat.
2. A. observe for bleeding
B. hematoma formation
C. infection
3. Infection at the incision site. It can be prevented by regular change of dressing.
A. model of the pacemaker
B. type of generator
C. date and time of insertion
D. site of the pulse generator
E. stimulation threshold
F. duration between atrial and ventricular impulses
5. Goals
A. free from infection
B. adherence to a self-care program
C. maintenance of pacemaker function
Nsg Interventions
A. Check incision site for skin discoloration, swelling, formation of hematoma, smell of discharge .
B. Educate patient and significant others on the proper care of the patient’s pacemaker, to monitor his/her heart rate, and involving the medical experts if any abnormalities persists.
C. Advise patient to avoid exposures to any electronic devices as it may interfere with the pacemakers function
Expected outcomes
A. Healing of wound at the incision site is more convenient if proper wound dressing and wound care is exercised by the patient.
B. Awareness of his/her condition may trigger the patient to be more careful on the care of the incision site and the pacemaker itself.
C. Patient will avoid areas as where his/her pacemaker faces dangers such as cellular phone transmission tower, radio stations, and TV stations.
6. Assessment Criteria
1. Manifestations of infection at the incision site.
2. Awareness of the patient and the family.
3. Overall function and care of having a client with pacemaker.
Mary Anne rose Domingo BSN4-A
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes because the response of the pacemaker is controlled by the activity of the patient’s heart, the pacemaker will not function when the patient’s heart beats but will pace if no beat is sensed. Triggered response means that the pacemaker will provide response when it senses intrinsic heart activity.
2. Nursing care includes incision site assessment for three complications:
a. bleeding
b. hematoma formation
c. infection
3. The most common postoperative complication is the dislodgement of the pacing electrode which can be prevented by restrict the patient activity on the side of the implantation
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. the model of the pacemaker
b. the type of generator
c. the date and time of insertion
d. the location of pulse generator
e. stimulation threshold
f. pacer setting
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a .absence of infection
b. adherence to a self care program
c. maintenance of pacemaker function
Nursing interventions:
A .monitor the patient complication such as infection, lead displacement, perforated ventricle, cardiac tamponade and lead fracture and disconnection.
b. observe for potential sources of electrical hazards
c . Teach the patient easy to use reduction technique such as deep breathing exercise.
Expected outcomes:
a. to remain the patient free from infection
b. patient should be cautioned to avoid such situation or to simply move further away from the area if they experience dizziness or a feeling of rapid irregular heartbeats
c. to help the patient to lessen the pain that they experience
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. the signs and symptoms at incision cite
b. the level of knowledge of the patient and the family and history to the therapeutic regimen should be identified
c. and the measurements and records of pulse rate at regular interval
1. Yes, it is expected for the reason that pacemakers can be inhbited or triggered. In his case, there is a possibility that the response of the pacemaker is controlled by the activity of his heart or the pacemaker sense an intrinsic activity of the heart.
2. a. local infection
b. formation of hematoma arround the insertion site
c. bleeding
3. The most common post-operative complication is the diplacement of the pacemaker catheter, electrode or the pacemaker itself that can be prevented by means of limiting the activity of the patient and securing the pacemaker very well so that even the patient will move, it will not be displaced.
4. a. model of pacemaker that is being used
b. the type of generator
c. the time and date of insertion
d. where the pulse generator located
e. stimulation treshold
f. the setting of pacemaker
5. Goals
a. infection prevention
b. adherence of patient to self care
c. maintain the function of the pacemaker
Nursing Interventions
* For letter a
- check the insertion site for signs and symptoms of infection like redness, swelling, odor and presence of pus.
* For letter b
- stressed to the pt and S/O about the importance of pacemaker.
- advised the pt not to used cellphone or other apparatuses that may interfere with the response of pacemaker.
Buenaobra, Michelle B.
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
> Yes because pacemakers are generally set to sense and respond to intrinsic activity of the not to control it so even the pacemaker was set to a constant rate it doesn't mean that this rate will be the rate of the heart.
2. Nursing care includes incision site assessment for three complications:
a.tachycardia
b.hemothorax
c. local infection
3. The most common postoperative complication is dislodgement of the pacing electrode which can be prevented by minimizing patient's activity.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. model of pacemaker
b. type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation threshold
f. pacer settings, sensitivity, and duration of interval between atrial and ventricular impulses.
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals: a. preventing infection
b. promoting effective coping
c. promoting home and community - based care
Nursing interventions: a. regular assessment of the site to check for redness, swelling, and soreness
b. recognize the patient's and family's emotional state and assist them to explore their feelings
c. teaching importance of periodic device monitoring, promoting safety, avoiding infection, avoiding EMI
Expected outcomes: a. remains free from infection
b. adheres to self - care program
c. maintenance of pacemaker function
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved. Expected outcomes: a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function Assessment criteria:
a. normal temperature, has WBC count @ normal range, absence of redness or swelling in the insertion site
b. reports signs and symptoms of infection, identifies when to seek madical attention, Adheres monitoring schedules, describes appropriate methods to avoid EMI, identify activities that are safe and those to avoid, and describes how to manage ICD shock event.
c. Measures and records pulse rate @ regular intervals, for those with pacemakers experience no abrupt changes in pulse rate or rhythm..
Rio Jane Rimbaud
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes, because the pacemaker will create reaction on if the heart rate is lower than normal.
2. Nursing care includes incision site assessment for three complications:
a. Bleeding
b. Hematoma formation
c. Infection: characterize by swelling, unusual tenderness, and increase body temperature
3. The most common postoperative complication is _dislodgement of the device_, which can be prevented by immobilizing the part of incision, and prevent touching the incision site.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. model of pacemaker
b. type of generator
c. date and time of insertion
d. Location of pulse generator
e. stimulation threshold
f. pacer setting (rate, energy output, AV delay)
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a.The patient must remain free from any infection.
b. The patient must know a self-care program.
b The patient must know how to maintain the function of the device.
Nursing interventions:
a. 0bserve incision site for any redness, swelling and for any increase in body temperature. Change the dressing of incision site regularly for and observe proper hygiene
b. Recognize the feeling of the patient as long with his/her family. Help the patient to develop interest to other activities. Teach him to identify sign and symptoms of the complications and to describe the advantage and disadvantage of having follow-up check-up.
c. Describe the importance of regular changing of battery unit of the pacemaker. Let him understand the importance of avoiding electromagnetic devices.
Expected outcomes:
a. the incision site remains free from infection, manifested by no swelling, redness and tenderness.
b. the patient adhere to self-care programs.
C. the patient understand the importance of maintaining the function of the devic
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection: The incision site is free or exhibit no swelling, tenderness, and redness. The patient temperature must be in normal range.
b. Adherence to a self-care program: The patient demonstrated concern on how to ovoid possible complication that may occur and identify some activities that are safe to do. He/she can identifies thing that should be avoided
c. Maintenance of pacemaker function: He/she understand the importance of maintaining the function of the device.
Assessment criteria:
a. No bleeding, swelling, tenderness noted at the incision site. And patient body temperature is within the normal range.
b. The patient demonstrated participation in maintaining his/her health. And following the right ideas on how to cope with his/her problems regarding the do’s and don’ts.
c. The patient was able to verbalized the importance of maintaining the device
ROGER S RUIZ JR
BSN 4-A
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
It is a normal on the part mr. ikero’ pacemaker it because our heart has a antrinsic activity
2. nursing care includes incision site assessment for three complications:
1. local infection rt the entry site of the leads for temporary pacing, or at the subcutaneous site for permanent generator placement
2. bleeding and hematoma at the lead entry site for permanent placement
3. hemothorax from puncture of the subclavian vein or i8n the imternal mammary artery
4. ventricular ectopy and tachycardia from irritation of ventricular wall by the endocardial electrode
5. movement or dislocation of the lead place transvenously ( perforation of the myocardium).
6. phrenic nerve, diaphgramatic ( hiccupping may be sign), or skeletal muscle stimulation if the lead is dislocate or if the delivered energy (Ma) is set high.
7. rarely cardiac tamponade from bleeding following removal of epicardial wires use for temporary pacing.
3. The most common postoperative complication is pace maker electrode dislodgement which can be prevented by .
1. proper and daily dressing and minimizing activity of the patient.
4. List six things about the pacemaker that must be noted on a patient’s chart:
1. model of pacemaker.
2. type of generator .
3. date and time of insertion.
4. location of pulse generator.
5. stimulation threshold.
6. pacer setting.
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
in meeting the three major goals of the patient is to prevent spreading infection, promoting the patient copping ability, and to tech the patient on how to established a plan in coping with their stress.
Nursing interventions:
1. as a nurse care provider you must observe the incision site daily for the redness, swelling and heat.
2. take temperature report any increase.
3. avoid tight restrictive clothing that may cause friction over the insertion site.
4. avoid large magnetic field such as those creates magnetic resonace imaging
5. and it must be the nurse to dress the insertion site and inspect the wound for any unusual discharges. And report it immediately.
Expected outcomes:
1. the patient will be remained from infections.
2. adheres toa self-care program.
3. maintain device function.
4. demonstrate and or describes an effective copping strategies.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
a. has a normal temperature.
b. has white blood cell within normal range ( 5000 to 10,000mm)
c. exhibit no redness or swelling of pacemaker insertion site.
b. Adherence to a self-care program
a. responds appropriately when queried about the signs and symptoms of infection.
b. identify on how to seek medical attention( as demonstrates in responses to signs and symptoms.)
c. adheres to monitor schedule.
d. describe the appropriate methods to avoid EMI.
E. identifies activity that are safe and those to avoid
f. for those with an ICD. Describe how they will manage ICD shock.
c. Maitenace of pacemaker function
a. measures pulse rate at regular intervals.
b. for those with pace makers, experience no abrupt changes in pulse rate or rhythm.
Assessment criteria: as a student nurse u must assess the patient with pace maker by advising the patient to monitor his heat rate and to under go in ECG. And assess the past recording ECG. And the present ECG result.
Mr. Bark lkero's pacemaker is set at 72 beats/minute. his heart rate is 76 beats/minute. Is this expected?9Yes.No) Explain the rationale of your answer.
yes it is expected because the other type of pacemaker doesn't controll the beating of the heart so there is a tendency that th heart rate of the patient will be slower or greater that bit that is being set ua at the pacemaker.
2. Nurses care include incision site assessment for three complications:
a. local infection
b. hematoma formation
c. bleeding
3. the most common post operative complicatio is the dislogdement of pacing electrode, which can be prevented by the activity restriction on the site of inplantation of pacemaker.
4. list six things about the pacemaker that must be noted on a patients chart:
a. model of pacemaker
b. type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation treshold
f. pacer setting
5.Describe nursing interventions and expected outcomes that should be used to met the three major goals of patient care.
Goals:
a. absence of infections
b. adherance to self care program
c. maintanance of pace maker funtion.
nsg. interventions:
a. change the dressing regularly and inspect the inertion site for redness swelling, soreness or any unusual drainage.
b. An increase in temp. should be reported to physician.
c. change in wound appearance and report to physician.
Outcomes:
a. free from any occurance of infections
b. adherance to self care program.
c. maintainance of pacemakr program.
6. Assessment criteria:
a. sign and symptoms of infection.
b. level of knowledge and learning needs of the patient.
c.functions of the pacemaker
LEAH VALDEZ
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes it is expected, because the pacemaker is react when the heart rate is lower than normal and has the ability to change the rate from moment to moment based on parameters such as physical activity temperature and oxygen saturation.
2. Nursing care includes incision site assessment for three complications:
a. Local infection
b. Bleeding
c. Hematoma formation
3. The most common postoperative complication is dislodgement of the pacing electrode, which can be prevented by minimizing patient activity, immobilized the patient extremity through which the catheter has been inserted and instructed the patient to restrict activity on the side of implantation.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. Model of pacemaker
b. Type of generator
c. Date and time of insertion
d. Location of pulse generator
e. Stimulation threshold
f. Paces setting
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a. Prevent infection
b. Promote effective coping
c. Promote home and community base care
Nursing interventions:
a. Change the dressing regularly and inspects the insertion site for redness, swelling, soreness or any unusual drainage.
b. Recognize the patient’s emotional state and assist the patient to explore his or her feelings. Help patient to identify perceived changes, the emotional response to change and how the patient responded to that emotion. Reassures the patient that the responses are normal, and then assist the patient to identify realistic goals and to develop a plan to attain those goals and teach the patient easy-to-use stress reduction techniques such as deep breathing exercise.
c. Teach the patient and home caregiver what are the importance of periodic pacemaker monitoring, promoting safety, avoiding infection and sources of electromagnetic interference.
Expected outcomes:
a. The patient remains free from infection as manifested by normal body temperature, WBC count with in normal range and exhibits no redness, soreness, swelling of pacemaker insertion site or any unusual drainage.
b. The patient respond appropriately when queried about the signs and symptoms of infection, identifies when to seek medical attention and described appropriate methods to avoid magnetic interference.
c. The patient can measure and records pulse rate at regular intervals, experience no abrupt changes in pulse rate or rhythm.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. Has in normal body temperature and exhibits no redness, soreness, swelling in the pacemaker insertion site and no unusual drainage.
b. The patient knows and understands how to avoid infection, describes appropriate methods how to avoid electromagnetic interference.
c. The patient knows between regular and irregular heart rate and rhythm.
Alvaro T. Graneta
BSN 4A
1.Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes.becouse the pacemaker that produses electric impulse of the heart,and programed in desired rate.
2. Nursing care includes incision site assessment for three complications:
a.infection of the site
b.hematoma
c.bleeding
3.The most common postoperative complication is dislodgement of pacing electrode, which can be prevented by encouraging the patient to limit activity to irritation and displacement to the site of implantation.
4. 6 things that must be included in the patients chart are:
1. model of the pacemaker
2. type of generator
3. date and time the pacemaker is inserted
4. location of pulse generator
5. stimulation threshold
6. pacer setting
5. Goals
a. infection prevention
b. adherence of patient to self care
c. maintain the function of the pacemaker
6. Assessment criteria:
a. sign and symptoms of infection.
b. level of knowledge and learning needs of the patient.
c.functions of the pacemaker
judilyn Pagaduan BSN-4A
Mr. Bart Ikero's pacemaker is set at 72 bpm. His heart rate is 76bpm. Is this expexted? (Yes/No). Explain the rationale for your answer.
> Yes, this is expected for the kind of the pacemaker that was controlled by the intrinsic activity of the heart. If only the pt's heartbeat was dropped or decreased that the times that the pacemaker will creates a heartbeat.
2. Nursing care includes incision site assessment for three complications:
a. Bleeding
b. Infection
c. Hematoma
3. The most common postoperative complication is the dislodgement of the pacing eletrode which can be prevented by limiting or minimizing patient's activity.
4. List six things about the pacemaker that must be noted on a patient's chart:
a. Type or model of pacemaker
b. Type of generator
c. Date and time of insertion
d. Location of pulse generator
e. Stimulation threshold
f. Pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the 3 major goals of pt.care.
Goals:
a. Prevents or absence of infection
b. Adherence of pt. to self care program
c. Effective coping
Nsg. Interventions:
a. Change dressing regularly, monitor or assess for redness and swelling of site
b. Educate pt. about the pacemaker, inform pt. when to seek medical advice and give information about the sign and symptoms of his condition
c. Include relatives in caring for the pt. Divert the pt's attention
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
> pt's remains free from infection, no redness or swelling at insertion site, pt is afebrile
>pt. is able to identify when to seek medical advice or check-up,
> pt. measures and records pulse rate at regular intervals
Vanessa Cayapan
1.Yes, it is expected because the heart has its own ability to respond or function though its connected to a pacemaker were in only the patients activity can able to manipulate the change in his pulse rate and in the pacemaker.
2.a.local infection
b.bleeding
c.hematoma at entry site
3.The most common postoperative complications is dislodgement of the pacing electrode which can be prevented by minimizing the patient activity.
4.model of pacemaker
type of generator
date and time of insertion
location of pulse generator
stimulation threshold
pacer settings
5. Goals
a.absence of infection
b.effective coping
c.maintenance the function of
the pacemaker
Nursing interventions
a.preventing infections by
change dressings,inspect
insertion site for redness swelling,soreness or any unusual drainage
b.recognizing pt. and family emotional state,teach patient stress reduction technique like deep breathing exercise
c.teaching patient selfcare like on how to monitor pacemaker,and the changes on his pule rate.
Expected Outcomes
a.the patient has no signs of infection and remains free to infection
b.pt. able to cope with his condition same to his significant others
c.able to know how to monitor and determine pulse rate.
6.a.the signs and symptoms of infection in the site,exhibits no redness or swelling to insertion site
b.pts. level of knowledge and to the significant others,identifies when to seek medical attention,identifies activities that are safe and those to avoid
c.measures and records pulse rate at regular intervals.
1.Yes,Mr.Bart Ikero's pacemaker is expected to increase or vary because in permanent pacemaker generator, the fourth letter of the code is related to its ability to be programmed or reset. In letter M which means multiprogrammability, there is the ability to change at least 3 factors namely:rate of pacing at which it is initiated(72/b/m), the rate of pacing (76 b/m)and the amount of energy delivered.
2. 3 Complications include:
- Local infection from entry sitedue to unchanged dressings
- Bleeding and Hematoma due to lead entry
- Hemothorax, due to puncture of subclavian vein or internal mammary artery that can fill thorax with blood
3.Most common postoperative complication is infection from the entry site which can be prevented through regular changing of dressings.
4. 6 things about the pacemaker:
-The pacemaker settings are noted & compared with ECG recordings to assess pacemaker function and to detect malfunction
-Check cardiac output and hemodynamic stability to identify patient's response to pacing and adequacy of pacing
-Incision site is observed for bleeding and hematoma which may be evidenced of unusual tenderness and discarges.
-Check patency of the pace.
-Check pacing
-Note if it is permanent or temporary pacemaker
5.Nursing Interventions:
-Assess the insertion site for bleeding, infection and hematoma. Dressing should be changed regularly to prevent swelling, redness & soreness.
-Identify coping strategies by teaching pt. to use stress-reduction techniques like deep-breathing exercises and to identify perceived changes after procedure has been done because
patient may feel angry, anxious, fearful and depressed about his illness.
- Promote home & community based care by instructing pt. to have regular check-ups and to include S.O. as his support system in giving him info. regarding importance of periodic pacemaker monitoring and to be aware of the effect of electromagnetic interference.
6.Assessment criterias:
-Freedom from infection-as evidenced by negative signs of swelling, redness and soreness.
-Adherence to self care program-pt. will comply with prescribed physical activity limitations and attend check-ups
-Maintenance of pacemaker function - pt. avoid electrical devices such as cellphones which will have direct interference with the work of the pacemaker
Milmar Nino Galpao BSN-4A
Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
> Yes, this is expected since Mr Bart Ikero is Tachydysrhythmia the pacemaker that was inserted to him is triggered by his fast heartbeats
2. Nursing care includes incision site assessment for three complications:
a. Infection
b. Bleeding
c. Hematoma
3. The most common postoperative complication is the dislodgement of the pacing electrode which can be prevented by avoiding or restriction of patient's activity.
4.List six things about the pacemaker that must be noted on a patient’s chart:
a.model of pacemaker
b.type of generator
c.date and time of insertion
d.location of pulse generator
e.stimulation threshold
f.pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a. Absence of infection
b. Attachment of the pt. to a self care program
c. Maintenance of the device function
Nsg. Interventions:
a. Clean and change dressing regularly
b. Teach pt. to seek medacal advice
c. Solicit or include pt's relatives or family for caring the pt.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Criteria assessment:
- absence of redness and swelling to the insertion site, pt's body temperature is normal
- Pt. is able to identify when to seek medical advice, responds when queried regarding sign and symptoms of infection
- Able to measures and records pulse rate at regular intervals
Melody N. Monzon
Mr.Bart Ikero,s pacemaker is set at 72 beats/minute His heart rate is 76 beats/minute.Is this expected?(yes/no)Explain the rationale for your answer.
1. Yes because pacemker has the ability to intrinsic the heart and the heart has the ability to control the pacemaker
2.Nursing care includes incision site assessment for three complications:
a.local infection
b.hematoma formation
c.bleeding
3.The most common postoperative complication is local infection st the entry site of the leads for temporary pacing, or at the subcutaneous site for permanent generator placement which can be prevented by change dressing daily and teach patient how to do self care daily.
4.List 6 things about the pacemaker that must be on the patient,s chart
a.date and time of insertion
b.location of pulse generator
c.model of pacemaker
d.type of generator
e.stimulation threshold
e.duration between atrial and ventricular impulses
5.Describe interventions and expected outcomes that should be use to meet the three major goals of patients care
Goals
a. absence of infection
b.adherence to a self care program
c.maintenance for pacemaker function
Expected outcomes
a.free or absence from infection
b.inhibits no redness or swelling of pacemaker in the incision site
c. remains free from infection with a normal body temp
Assessment
a.after a temporary or a permanent pacemaker is inserted, the patients heart rate and rythym are monitored by ECG
b.assessed thev cardiac output and hemodynamic stability to identify the patient,s responce to pacing the adequacy of pacing
c. assessed for anxiety
cathellyn v. coronan
BSNIV-A
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
>Yes, it is expected because pacemaker has an intrinsic ability to respond easily
2.) Nursing care includes incision assessment for three complications such as:
a.) local infection
b.} bleeding & hematoma @ the lead entry sites
c.) hemothorax
3.) The most common postoperative complication is dislodgement of pacing electrode which ca be prevented by activity restrictions on the site of implantation
4.) List six things about the pacemaker that must be noted on a patient's chart
>date of insertion
>model of pacemaker
>the type of generator
>location of puise generator
>stimulation threshold
>the pacemaker settings
5.) Described the nursing interventions & expected outcome that should be used to meet the three major goals of patient care.
a.) Prevent infection
b.) Promote effective coping
c.) Promoting homw & community based care
Nursing interventions
a.) Always change the dressing regularly
b.) Teach patient regarding on stress rduction technique
c.) Solicit the cooperation of the relative
Expected outcomes
a.) Patient remains free from infection
b.) Patient adheres to a self - care program
c.) Maintained pacemaker function
6.) List assessment criteria that should be used to determine whether expected outcomes of care are achieved
expected outcomes
a.) Freedom from infection
b.) Adherence to a self care program
c.) Maitenance of pacemaker function
assessment criteria
a.) signs of infection
b.) existing knoledge & learning needs of the patient & family
c.)records of pulse rate, & rhythm & the pacemaker function
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes, because Mr. Bar has a tachydysrhythmia disorder, so it is expected for him to have a heart rate of 76 beats per minute. The pacemaker is set to 72 bpm to maintain the noramal heart rate for Mr. Bar.
2. Nursing care includes incision site assessment for three complications:
a.Observe wound for infection. ( local infection- sepsis or hematoma formation)
b.Inspect for redness, swelling and or bleeding on the entry site.
c.Observe for the vein through which the pacing catheter has been placed for evidences of phlebitis.
3. The most common post- op complication is dislodgement of the pacing electrode which is prevented by minimizing patient’s activity.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. Model of pacemaker
b. Type of generator
c. Date and time of insertion
d. Location of puls generator.
e. Stimulation threshold
f. Pacer settings
Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a.prevention of infection
b.adherence of patient to a self care program
c.patient maintains pacemaker functions
nsg. care
a. Provide information about the implantation of device before the operation to patient as well as the family or s.o.
b. Manage episodes of dysrhythmias that may threaten patient’s life.
c. Monitor for patient’s responses to the device and provide further information and health teachings about pacemaker therapy and its importance.
Teachings may include:
• Promoting safety for the patient
• Avoiding infection at home
• Stress reduction technique
• Distinguishing abnormal signs from the normal.
• Identify the sources of electromagnetic interference such as television, cellphones and microwaves.
Expecetd outcomes:
a. - There are no signs and symptoms of hematoma, no bleeding, redness, swelling or moisture on the entry site.
b. - Adheres to monitoring schedule.
- Know some informations or methods in avoiding infection.
- Pt. does or identifies activities that are safe.
- They know what to do in case of shock event.
c. - Pt. able to manage her dressings and shows no signs on the incision site.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
a. Freedom of infection
- There are no signs and symptoms of hematoma, no bleeding, redness, swelling or moisture on the entry site.
- Patient don’t have an increase in temperature.
- No increase in WBC which is an indicative of infection.
b. Adherence to self acre program
- Patient already has a regular check ups
- Pt. demonstrates daily self care activities.
-The pt. already know when to seek medical attention
- Adheres to monitoring schedule.
- Know some informations or methods in avoiding infection.
- Pt. does or identifies activities that are safe.
- They know what to do in case of shock event.
Jonathan Tabios
BSN 4A
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
A.
no, because pacemakers is the one who sent stimuli to the heart muscles
2. Nursing care includes incision site assessment for three complications:
A.
1. local infection
2. bleeding
3. hematoma
3. The most common postoperative complication is dislodgement of pacing electrode, which can be prevented by mimizing the activity of the patient.
4. List six things about the pacemaker that must be noted on a patient’s chart:
A.
1. model of pacemaker
2. type of generator
3. date and time of insertion
4. location of pulse generator
5. stimulation threshold
6. pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
1. absence of infection
2. effective coping
3. adherence to self-care program
Nursing interventions:
1. change dressing as needed and always check or assess the insertion site for redness, swelling, soreness, or any unusual drainage. monitor patient's body temp(an increase in temp should be reported to the physician).
2. identify and evaluate patient's coping strategies if effective. plan coping management (spend more time to patient, teach how to do relaxation, emphasize the dos and dont’s of pacemaker therapy).
3. advise patient to have regular check-up. teach how to avoid infection, then promote safety.
Expected outcome:
1. patient remains free of infections.
2. patient will able to perform effective coping strategies.
3. patient will comply to why is instructed.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
1. Freedom from infection
2. Adherence to a self-care program
3. Maintenance of pacemaker function
Assessment criteria:
1. has normal body temperature, has WBC count within normal range, and exhibits no redness or swelling on pacemaker insertion site.
2. responds appropriately when queried about the signs and symptoms of infection, identifies when to seek medical attention, adheres to monitoring schedule, describes appropriate methods to avoid EMI, and identifies activities that are safe and those to avoid.
3. measures and records pulse at regular intervals, and experience no abrupt changes in pulse rate and rhythm.
1.Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes because the heart has the ability to control the pacemaker and since the patient is tachydysrhythmia.
2. Nursing care includes incision site assessment for three complications:
a.local infection at the entry site
b.bleeding and hematoma at the lead entry site
c.hemothorax from puncture of the subclavian vein
3.The most common postoperative complications is dislodgement of the pacing electrode which can be prevented by minimizing the patient activity.
4.List six things about the pacemaker that must be noted on a patient’s chart:
a.model of pacemaker
b.type of generator
c.data and time of insertion
c.location of pulse generator
d.stimulation threshold
e.pacer setting,sensitivity and duration
5.Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
goals:
a.absence of infection
b.adherence to self-care program
c.maintenance of pacemaker function
nursing interventions:
a.preventing infection by changes the dressing regularly and inspects the insertion site for redness,swelling,soreness and increase in temperature should be reported to the physician.
b.promote effective coping by spend more time to the patient,solicit the cooperation of the relatives,teach the patient stress reduction technique,by pursed lip breathing.
c.teaching patient self-care by promote safety,teach the important of pacemaker monitoring,teach how to avoid infection at home,identify the sources of electromagnetic interference like welding,electrical substations.
expected outcomes:
a.remains patient free of infection,no redness,swelling,soreness,or any unusual drainage
b.adheres to self-care program
c.maintenance of pacemaker function
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
a.remains free of infection
-has normal temperature
-has WBC count within normal range
-exhibits no redness or swelling pacemaker in insertion site
b.adheres to a self care program
-responds appropriately when queried about the signs and symptoms of infection
-identifies when to seek medical atention
-adheres to monitoring schedule
c.maintains pacemaker function
-measures and record pulse rate at regular intevals
-experience no abrupt changes in pulse rate or rhythm.
Cariaga Leonardo
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes because pacemaker have ability to provides an electrical stimuli to the heart, the demand of the pacemaker will activate when the heart rate drops
2. Nursing care includes incision site assessment for three complications:
a. Local infection at the entry site
b. Bleeding and hematoma
c. Dislocation
3. The most common postoperative complication is infection which can be prevented by activity monitoring and cleaning at the entry site of lead
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. Model of pacemaker
b. Type of generator
c. Date and time of insertion
d. Location of pulse generator
e. Stimulation threshold
f. Pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a. Absence of infection
b. Effective coping
c. Patient maintains pacemaker functions
Nursing interventions:
a. Monitor incision site for signs of infection; like redness, or swelling, fever, pain, tenderness, color and smell of discharges, and heat. Regular changes of dressing.
b. Expend more time to our pt. Elicit rather the cooperation of the relative. Teach the pt stress reductive technique like deep breathing exercise.
c. Advise to monitor when battery depletion is anticipated. Check pulse daily and report immediately any sudden slowing or increasing of the pulse rate these may indicate pacemaker malfunction. Describe the importance in reporting to physician so that pacemaker’s rate and function can monitor.
Expected outcomes:
a. The pt absence of infections
b. The pt able to describes an effective coping strategies.
c. The pt experiences no abrupt changes in heart rate rhythm.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. Signs and symptoms of infection like redness, swelling or any presence of moisture
b. The existing level of knowledge and learning needs of patient and family
c. functioning of pacemaker will maintain by assessing the deviation of the heart rate and rhythm.
Goals:
1. absence of infection
2. effective coping
3. adherence to self-care program
Nursing interventions:
1. change dressing as needed and always check or assess the insertion site for redness, swelling, soreness, or any unusual drainage. monitor patient's body temp(an increase in temp should be reported to the physician).
2. identify and evaluate patient's coping strategies if effective. plan coping management (spend more time to patient, teach how to do relaxation, emphasize the dos and dont’s of pacemaker therapy).
3. advise patient to have regular check-up. teach how to avoid infection, then promote safety.
Expected outcome:
1. patient remains free of infections.
2. patient will able to perform effective coping strategies.
3. patient will comply to why is instructed.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
1. Freedom from infection
2. Adherence to a self-care program
3. Maintenance of pacemaker function
Assessment criteria:
1. has normal body temperature, has WBC count within normal range, and exhibits no redness or swelling on pacemaker insertion site.
2. responds appropriately when queried about the signs and symptoms of infection, identifies when to seek medical attention, adheres to monitoring schedule, describes appropriate methods to avoid EMI, and identifies activities that are safe and those to avoid.
3. measures and records pulse at regular intervals, and experience no abrupt changes in pulse rate and rhythm.
JEREIL D. BARENG BSN-IV-A
Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
ANSWERS
1. Yes, because Bart Ikepo is with tachydysrythmia, they set the pacemaker for 72bpm for his recovery in tachydysrythmia, but it is expected that his heart rate is increase because of some instances that he may be encountered or exposed to electromagnetic interferences or radiations.
2.three complications are:
a. bleeding at the insertion site
b. hematoma at the lead entry sites for temporary pacing
c. infection
3. the most common pacemaker post-operative complication is the dislodgement of the pacing electrode which prevented by minimizing patient activity.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. model of pacemaker
b. type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation threshold
f. pacer settings(e.g. rate, energy output(mA), sensitivity (mV), and duration of interval between atrial and ventricular impulses (AV delay)
5. three main goals
1. Absence of infection/Preventing infection
2. Promote effective Coping
3. Teaching the patient’s “Self-Care”
Nursing Interventions
1.absence of infection
• the nurse changes the dressings as needed and inspects the insertion site for redness, swelling, soreness or any unusual drainage.
• an increase in the patient’s temperature should be reported to the physician
2. Promote effective coping
• the nurse must recognize the patient’s as well as the family’s emotional state and assist them to explore their feelings.
the nurse may help the pt. indentify perceived changes, the emotional response to the change and how the pt. responds to that emotion.
• the nurse reassures the pt. that the responses are normal and then helps the pt. identify realistic goals, and develop a plan to attain these goals.
• the pt. and family should be encourage to talk about their experience and emotions with each other and the health care team.
• the nurse may refer the pt. and family to a hospital, community or online support group
• the nurse may also teach the pt. easy-to-use- stress reduction techniques to facilitate coping
- instructing the pt. about the ICDE may help the pt. to cope with changes that occur as a result of device implantation
3.Teaching the patient’s “Self-Care”
• Promote regular check-up
• include the home caregiver in teaching and provide materials for use by the pt. and caregiver
• teach pt. and the caregiver on how to avoid infection at home
• promote safety
• teach the periodic pacemaker monitoring to the pt. and to the caregiver
• identify the sources of electromagnetic interference like electrical substations
• educate the pt. and caregiver for not allowing to used microwave, ovens,cellphons and other EMI
• Educate the pt. and the caregiver for periodic changing in batteries
Expected Outcomes
a. Patient will free from any infection
b. Patient will adhere to a “self-care”
c. Patient pacemaker function is maintained
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
1. Remains free of infection
a. Has normal temperature
b. Has White blood cell count within normal range (5000-10,000/mm
c. Exhibits no redness or swelling of pacemaker insertion site
2. Adheres to a self-care program
a. Responds appropriately when queried about the signs and symptoms of infection
b. Identifies when to seek medical attention (as demonstrated in responses to signs and symptoms)
c. Adheres to monitoring schedule
d. describes appropriate methods to avoid EMI
e. Identifies activities that are safe and those to avoid for those with an ICD, describes how they will manage an ICD Shock event
3. Maintains device function
A. Measures and records pulse rate at regular intervals
b. For those with pacemakers, experiences no abrupt changes in pulse rate or rhythm
Assessment Criteria
a.has normal temperature,WBC count,Exhibits no redness or swelling of pacemaker insertion site
b. describes appropriate methods to avoid EMI
c. responds appropriately when queried about the sings and symptoms of infection.
marlon sabado
1.Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes, the work of pacemaker is to maintain only the heart rate of 72beats/min. on the other hand the pacemaker can not control the beats of the heart of the pt. but when patient's heart rate decrease in that set rate, his pacemaker will stimulate electrical impulse to the heart muscle to maintain the normal set of heart beats/min.
2. Nursing care includes incision site assessment for three complications:
a. local infection
b. bleeding
c. hematoma
3. complication - dislodgment of the pacing electrode, minimizing patient activity on the side of the implantation
4. List six things about the pacemaker that must be noted on a patient’s chart:
1.model of pacemaker
2.type of generator
3.date and time of insertion
4.location of pulse generator
5.stimulation threshold
6.pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
1. absence of infection
2. effective coping
3. adherence to self-care program
Nursing interventions:
1. change dressing as needed and always check or assess the insertion site for redness, swelling, soreness, or any unusual drainage. monitor patient's body temp(an increase in temp should be reported to the physician).
2. identify and evaluate patient's coping strategies if effective. plan coping management (spend more time to patient, teach how to do relaxation, emphasize the dos and dont’s of pacemaker therapy).
3. advise patient to have regular check-up. teach how to avoid infection, then promote safety.
Expected outcome:
1. patient remains free of infections.
2. patient will able to perform effective coping strategies.
3. patient will comply to why is instructed.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
1. Freedom from infection
2. Adherence to a self-care program
3. Maintenance of pacemaker function
Assessment criteria:
1. has normal body temperature, has WBC count within normal range, and exhibits no redness or swelling on pacemaker insertion site.
2. responds appropriately when queried about the signs and symptoms of infection, identifies when to seek medical attention, adheres to monitoring schedule, describes appropriate methods to avoid EMI, and identifies activities that are safe and those to avoid.
3. measures and records pulse at regular intervals, and experience no abrupt changes in pulse rate and rhythm.
Lorena Mamauag
Mr.Bart Ikero,s pacemaker is set at 72 beats/minute His heart rate is 76 beats/minute. Is this expected?(yes/no)Explain the rationale for your answer.
1.Yes because depend upon the type of response by the pacemaker to what is sensed and adoption of our body and the ability of the heart.
2. Nursing care includes incision site assessment for three complication :
a. observed for bleeding
b. observed formation of hematoma, in which may be evidenced of swelling
c. Observed for unusual drainage and tenderness and increase heart rate.
3. The most common postoperative dislodgment of pacing electrode, which can be prevented by minimizing activity of the patient.
4. List six things about the pacemaker that must be noted on a patient’s chart:
A. model of pacemaker
b. Type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation threshold,
f. pacemaker setting (rate, energy, duration between atrial and ventricular impulse
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
GAOLS
a. absence of infection
b. Effective coping
c. Adherence to elf care
NURSING INTERVENTION
a. preventing infection
-Dress at the insertion site may changed frequently
-Check for any unusual discharged and odor
-Check for redness and swelling of insertion site
b. Effective Coping
-Nurse must be spent more time in patient
-Teach patient use individual coping process like prayer, communication with significant others to manage emotional distress
-Assist the patient to explore his or her feeling
-help patient to identify perceived changes like loss of ability to participate in contact sports, the emotional response to that emotion like anger
-teach patient easy-to-use stress reduction techniques like deep-breathing exercises
c. Self care
-teach patient the importance of periodic pacemaker monitoring, promoting safety, avoiding infection
-Teach the home caregiver in the teaching and provided printed materials for use by the patient and caregiver.
EXPECTED OUTCOME
a. Preventing Infection
-patient free infection, no sign and symptoms redness and swelling
b. Effective Coping
-Patient willing to response and cooperate
c. self care
-patient identify to seek medical attention and demonstrated in response to sign and symptoms
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected Outcome
a. Freedom from infection
b. Adherence to self –care program
c. Maintenance of pacemaker Function
Assessment Criteria
a. changed in skin appearance and temperature
b. patient and family is well knowledge
c. pacemaker function, heart rate and rhythm
Lorena Mamauag
Mr.Bart Ikero,s pacemaker is set at 72 beats/minute His heart rate is 76 beats/minute. Is this expected?(yes/no)Explain the rationale for your answer.
1.Yes because depend upon the type of response by the pacemaker to what is sensed and adoption of our body and the ability of the heart.
2. Nursing care includes incision site assessment for three complication :
a. observed for bleeding
b. observed formation of hematoma, in which may be evidenced of swelling
c. Observed for unusual drainage and tenderness and increase heart rate.
3. The most common postoperative dislodgment of pacing electrode, which can be prevented by minimizing activity of the patient.
4. List six things about the pacemaker that must be noted on a patient’s chart:
A. model of pacemaker
b. Type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation threshold,
f. pacemaker setting (rate, energy, duration between atrial and ventricular impulse
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
GAOLS
a. absence of infection
b. Effective coping
c. Adherence to elf care
NURSING INTERVENTION
a. preventing infection
-Dress at the insertion site may changed frequently
-Check for any unusual discharged and odor
-Check for redness and swelling of insertion site
b. Effective Coping
-Nurse must be spent more time in patient
-Teach patient use individual coping process like prayer, communication with significant others to manage emotional distress
-Assist the patient to explore his or her feeling
-help patient to identify perceived changes like loss of ability to participate in contact sports, the emotional response to that emotion like anger
-teach patient easy-to-use stress reduction techniques like deep-breathing exercises
c. Self care
-teach patient the importance of periodic pacemaker monitoring, promoting safety, avoiding infection
-Teach the home caregiver in the teaching and provided printed materials for use by the patient and caregiver.
EXPECTED OUTCOME
a. Preventing Infection
-patient free infection, no sign and symptoms redness and swelling
b. Effective Coping
-Patient willing to response and cooperate
c. self care
-patient identify to seek medical attention and demonstrated in response to sign and symptoms
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected Outcome
a. Freedom from infection
b. Adherence to self –care program
c. Maintenance of pacemaker Function
Assessment Criteria
a. changed in skin appearance and temperature
b. patient and family is well knowledge
c. pacemaker function, heart rate and rhythm
Catherine S. Pagbilao
1. Yes it can be, because pacemaker is a unit design to stimulate the ventricle, only when ventricular contraction occurs below the normal rate oe drops in a specified rate.
2. Nursing care includes incision site assessment for the three complications.
a. Local Infection (sepsis or hematoma) @ the site of venous cutdown
b. Ventricular ectopic activity from irritation of the ventricular wall by the electrode.
c. Electrode malposition
3. The most common postoperative complication is "infection", which can be prevented by "regular wound dressing".
4. List of six things about pacemaker that must be noted on a pt's chart.
1. model of pacemaker (pulse generator and Pacemaker Electrodes)
2. Type of generator
3. Date and Time of insertion
4. Location of pulse generator.
5. Stimulation threshhold
6. Pacer Settings
5. Describe nursing interventions,goals and expected outcome.
GOALS:
a. Absence from infection
b. Effective coping strategies
c. Adherence to a selfcare program
NURSING INTERVENTIONS:
a. Prevent infection by regular wound dressing.
b. Promote effective coping strategies by encouraging the family members to participate in the activity.
c. Promote self care technique by teaching the pt. stress reduction technique such as deep breathing exercise.
EXPECTED OUTCOMES
a. Remains free from infection
b. Adheres to self care program
c. Demonstrate an effective coping strategy
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
a. Free from infection
= pt. has a normal body temperature
= WBC is in the normal range
b. Adherence to a selfcare program
= Pt. respond appropriately when queried about signs and symptoms
= Pt identify when to seek medical attention
= Adheres to monitoring schedule
= Identifies those activities that are safe and not
c. Maintenance of Pacemaker function
= Measures and records pulse rate @ regualr intervals
= Experiences no abrupt changes in pulse rate or rhythm.
Precious Joy Vallente
Mr.Bart Ikero's pacemaker is set at 72beats/minute.HIs heart rate is 76 beat/minute. Is this expecte? (yes/no)explain the rationale for your answer.
-Yes this can be expected because it is depend on the response of the the pacemaker in the heart activity,even though that there is a pacemaker it doesn't mean that the pacemaker can maintain the heart rate of the heart it is depends also in the activity of the heart.
2.Nursing care includes incision site assessment for three complition:
-local infection
-bleeding
-hematoma formation
3.The most complication is the dislodgement of pacing electrode.It can be prevented by restricted activity especially on the incision site.
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. model of pacemaker
b.type of generator
c. date and time of insertion\
d. location of pulse generator
e. stimulation threshold
f.duration between atrial and venticular impulses
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
-to prevent from infection
-adherence to a self-care program
-effective coping
A.proper would dressing,always monitor for any sign and symptoms of infection like swelling,pain, tenderness,color discharges and fever
b.educate the patient about the important information of the pacemaker.and the importance of caring his self especially his emotion
c.it is important to teach patient
on how to move on with his condition to avoid having stress that can be cause of problem in the function of his pacemaker.the adjustment should be include the family of the patient
6. Assessment Criteria
- it is important to asses the infection at the incision site.
- Awareness of the patient of having pacemaker including his/her family
-asses the function of the pacemaker the heart rate and rhthm.
Shyrlaureta
1. Mr. Bart Ikero's pacer is set at 72 beats/min. his heart rate is 76 beats/minute. is this expected? (yes/no) explain the rationale for your answer.
-yes this is expected because of the ability of the intrinsic ability of the heart that controls the activities, the heart can control the pacemaker that is the reason why the pacemaker reaches 76beats/minute.
2. nursing care includes incision site assessment for three complications:
a.infection
b. bleeding
c. hematoma formation
3. The most common postoperative complication is dislodgement of the pacing electrode which can be prevented by minimizing activities.
4.List 6 things about the pacemaker that must be noted on pt's chart:
a. pacemaker design and types
b. type of generator
c. date and time of insertion
d. location of pulse generator
e. stimulation threshold
f. pacer setting
5. Describe nursing interventions and expected outcomes that should be use to meet the 3 major goals of pt care
goals
a. absence of infection
b. adherence to self-care program
c. maintenance of pacemaker function
expected outcomes
a.free from infection we need to maintain the incision clean and dry
-inhibits no redness or swelling of pacemaker in the incision site
-remains free from infection with a normal body temperature
b.adherence to self-care program
-responds appropriately when queried about the signs and symptoms of infection
c.maintained pacemaker functions
-measures and records pulse rate at regular intrvals
-experience no abrupt changes in pulse rate ao rhythm
6. assessment criteria:
a. signs and symptoms of infection ( body temperature, wbc count within normal range, swelling and redness)
b.level of learnings regarding the care of pt with pacemaker
c.pacemaker function, its rate and rhythm.
JUNETTE JOY A. ADA
1. YES, It is expected because pace maker has the ability to sense the activity of the heart and it is set to the desired rate that the patient needs.
2.THREE COMPLICATIONS
a. infection at the insertion sight.
b.hematoma
c. bleeding
3.Common complication is the dislodgement of the pacing electrode and we can prevent it by restricted patient activity on the site of implantation.
4.SIX THINGS ABOUT THE PACEMAKER THAT MUST BE NOTED ON A PATIENTS CHART.
a.model of pace maker
b.type of generator
c.date and time of insertion
d.location of pulse generator
e.stimulation treshhold
f.pacer settings
5. A. GOALS
1. prevent infection
2. adherence of patient to self care
3. effective coping
B. INTERVENTIONS
a. daily dressing at the insertion site.
b.the patient will be able to know how to take care of herself even at home and will be able to demonstrate appropriate care needed to his/her situation.
c. stay beside the patient for divertional activities and instruct the patient family to stay with him/her most of the time for support.
6. ASSESSMENT CRITERIA
a. signs and symptoms of infection,
b.level of knowledge of the patient and family about the device, adherence to the therapeutic regimen will be identified.
c.function of the pace maker the do's and dont's when having pace maker. regular record of apical pulse.
RACHELLE ANNE B. GINEZ
BSN4-A
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
>yes,pacemakers are generally set to sense & respond to activity.
2. Nursing care includes incision site assessment for three complications:
>a.local infection at the entry site
>b.bleeding and hematoma
>c.hemothorax
3. The most common postoperative complication is*dislodgement of the pacing electrode, which can be prevented by *minimizing patient activity.
4. List six things about the pacemaker that must be noted on a patient’s chart:
>a.model of pacemaker
>b.type of generator
>c.date & time of insertion
>d.location of pulse generator
>e.stimulation thresholds
>f.pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
>a.absence of infection
>b.effective coping
>c.adherence to self-care program
Nursing interventions:
>a.regular checking & dressing of the insertion site
>b.teach patient easy-to-use stress reduction techniques.(e.g deep breathing exercises) to facilitate coping
>c.teach patient & S.O the importance of periodic pacemaker monitoring,avoiding infection ,promoting safety & avoiding sources of electromagnetic interference.
Expected outcomes:
>a.remains free of infection
>b.adheres to self-care program
>c.maintains pacemaker function
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a.>has a normal WBC count within the normal range
>has a normal temperature
>exhibits no redness or swelling of pacemaker insertion site
b.>adherence to monitoring schedule & describes appropriate methods to avoid electromagnetic interference
>identifies when to seek medical attention
c. >measures and records pulse rate at regular intervals
>experiences no changes in pulse rate or rhythm
1. yes
2. a. local infection at the entry site.
b. bleeding and hematoma
c. hemothorax from puncture of subclavian vein
3. local infection - history taking and several laboratory exams
4.
5.absence of infection
adherence to self care program
effective coping and maintenance of pacemaker mal function
nursing interventions
prevention of infection
to promote effective coping mechanism and to promote home and community base care
expected outcomes
remains free of infection
adheres to self care program
maintainspacemaker function
6.
a-has normal temp
b-responds appropriately when queried about the signs and symptoms of infection
measures and records pulse rate and regular intervals
1. yes
2. a. local infection at the entry site.
b. bleeding and hematoma
c. hemothorax from puncture of subclavian vein
3. local infection - history taking and several laboratory exams
4.
5.absence of infection
adherence to self care program
effective coping and maintenance of pacemaker mal function
nursing interventions
prevention of infection
to promote effective coping mechanism and to promote home and community base care
expected outcomes
remains free of infection
adheres to self care program
maintainspacemaker function
6.
a-has normal temp
b-responds appropriately when queried about the signs and symptoms of infection
measures and records pulse rate and regular intervals
1. yes
2. a. local infection at the entry site.
b. bleeding and hematoma
c. hemothorax from puncture of subclavian vein
3. local infection - history taking and several laboratory exams
4.
5.absence of infection
adherence to self care program
effective coping and maintenance of pacemaker mal function
nursing interventions
prevention of infection
to promote effective coping mechanism and to promote home and community base care
expected outcomes
remains free of infection
adheres to self care program
maintainspacemaker function
6.
a-has normal temp
b-responds appropriately when queried about the signs and symptoms of infection
measures and records pulse rate and regular intervals
Von Ryan Apellanes
BSN-4A
1. Yes, the said set 72 beats can may be increased because the peacemaker has the function to control or to produce normal impulses that the heart can gives, but if the heart change in beat, it is possible to increase but not to decrease heart rate.
2. a. Local Infection ; clean area at regular change of dressing ; inspection of entry sites.
b. Bleeding; ensure safety; minimize patient activity to prevent bleeding.
c. Hematoma; assess for redness and swelling clean site to prevent further infection.
3. The most common postoperative complication is dislodgement of the pacing electrode, which can be prevented by minimizing the patient activity.
4. a. Model of Pacemaker
b. type of generator
c. date and time of insertion
d. Location of pulse generator
e. stimulation threshold
f. pacer setting
5. Goals
a. to prevent further infection
b. adherence to a self care program
c. maintenance of device function
Nursing Interventions
a. regular change dressing; inspection and cleaning sites.
b. Advised patient to have a regular check-up
c. advised patient to avoid exposure to radiation and electrical wave that results in interfering on the device function
6. Assessment Criteria
a. The patient will have normal temperature; exhibits no redness and swelling of pacemaker sites
b. The patient can responds appropriately when queried about the signs and symptoms of infection; and adheres to monitoring schedule.
c. The patient can measures his own pulse rate record at regular intervals.
Jasper
1.Yes.
2.Nursing care includes incision site assessment for three complition:
-local infection
-bleeding
-hematoma formation
3. The most common postoperative complication is dislodgement of the pacing electrode, which can be prevented by minimizing patient's activity. with a permanent pacemaker, the patient is instructed to restrict activity on the side of the implantation.
4. List six things about the pacemaker that must be noted on a patient's chart:
a. Type or model of pacemaker
b. Type of generator
c. Date and time of insertion
d. Location of pulse generator
e. Stimulation threshold
f. Pacer settings
5. Goals
a.absence of infection
b.effective coping
c.maintenance the function of
the pacemaker
Nursing interventions
a.preventing infections by
change dressings,inspect
insertion site for redness swelling,soreness or any unusual drainage
b.recognizing pt. and family emotional state,teach patient stress reduction technique like deep breathing exercise
c.teaching patient selfcare like on how to monitor pacemaker,and the changes on his pule rate.
Expected Outcomes
a.the patient has no signs of infection and remains free to infection
b.pt. able to cope with his condition same to his significant others
c.able to know how to monitor and determine pulse rate.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
1. Freedom from infection
2. Adherence to a self-care program
3. Maintenance of pacemaker function
Assessment criteria:
1. has normal body temperature, has WBC count within normal range, and exhibits no redness or swelling on pacemaker insertion site.
2. responds appropriately when queried about the signs and symptoms of infection, identifies when to seek medical attention, adheres to monitoring schedule, describes appropriate methods to avoid EMI, and identifies activities that are safe and those to avoid.
3. measures and records pulse at regular intervals, and experience no abrupt changes in pulse rate and rhythm.
Pearl Luis
1.Yes, it is expected because the heart has its own ability to respond or function though its connected to a pacemaker were in only the patients activity can able to manipulate the change in his pulse rate and in the pacemaker.
2. Nursing care includes incision site assessment for three complications:
a. local infection
b. bleeding
c. hematoma formation
all at the lead entry sites for temporary pacing, or at the subcutaneous site for permanent generator placement
3. The most common postoperative complication is _dislodgement of the device_, which can be prevented by immobilizing the part of incision, and prevent touching the incision site.
4. List six things about the pacemaker that must be noted on a patient’s chart:
1.model of pacemaker
2.type of generator
3.date and time of insertion
4.location of pulse generator
5.stimulation threshold
6.pacer settings
5.absence of infection
adherence to self care program
effective coping and maintenance of pacemaker mal function
nursing interventions
prevention of infection
to promote effective coping mechanism and to promote home and community base care
expected outcomes
remains free of infection
adheres to self care program
maintainspacemaker function
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
1. Freedom from infection
2. Adherence to a self-care program
3. Maintenance of pacemaker function
Assessment criteria:
1. has normal body temperature, has WBC count within normal range, and exhibits no redness or swelling on pacemaker insertion site.
2. responds appropriately when queried about the signs and symptoms of infection, identifies when to seek medical attention, adheres to monitoring schedule, describes appropriate methods to avoid EMI, and identifies activities that are safe and those to avoid.
3. measures and records pulse at regular intervals, and experience no abrupt changes in pulse rate and rhythm.
Mr. Bart Ikero is a 58-year-old man who is scheduled for permanent pacemaker insertion as treatment for a tachydysrhythmia that doesn’t respond to medication therapy. He will have an endocardial implant. Answer the following questions based on your knowledge of pacemaker management (reference pages 700–705).
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
Yes. Because pacemaker responds base on the activity of the patient’s heart.
2. Nursing care includes incision site assessment for three complications:
a. Bleeding
b. Infection
c. Hematoma
3. The most common postoperative complication is dislodgement of the pacing electrode which can be prevented by limiting the patient’s activities..
4. List six things about the pacemaker that must be noted on a patient’s chart:
a. Type or model of pacemaker
b. Type of generator
c. Date and time of insertion
d. Location of pulse generator
e. Stimulation threshold
f. Pacer settings
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a. Patient should be free from infection
b. Patient should be cooperative to a self-care program
c. Patient should know how to maintain the pacemaker functions.
Nursing interventions:
a. Change the dressing regularly and inspects the insertion site for redness, swelling, soreness or any unusual drainage.
b. Inform pt. about the pacemaker and its possible complications and advise patient to seek medical advice if there’s a complication.
c. Instruct patient to avoid electrical devices like cellphones and microwave oven because it will cause a direct interference with the work of the pacemaker.
Expected outcomes:
a. Patient will be free from infection.
b. Patient cooperate in self-care program.
c. Patient maintain the pacemaker functions.
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. Free from infection as evidenced by no signs of redness, swelling and soreness or any usual drainage.
b. Patient cooperated in caring on his condition about the pacemaker.
c. Patient did not use any electrical devices.
Pearl Luis
BSN 1V-A
1. Mr. Bart Ikero’s pacemaker is set at 72 beats/minute. His heart rate is 76 beats/minute. Is this expected? (Yes/No) Explain the rationale for your answer.
ans:
yes,because it is base on the type of pacemaker that sense the intrinsic ability of heart of mr. Bark Ikero's
2. Nursing care includes incision site assessment for three complications:
a. local infection
b. hematoma formation
c.bleeding
all at the lead entry sites for temporary pacing, or at the subcutaneous site for permanent generator placement
3. The most common postoperative complication is dislodgement of the pacing electrode, which can be prevented by minimizing patient's activity. with a permanent pacemaker, the patient is instructed to restrict activity on the side of the implantation.
4. List six things about the pacemaker that must be noted on a patient’s chart:
ans:
a. model of pacemaker
b. date and time of insertion
c. location of pulse generator
d.duration between atrial and venticular impulses.
e.pacer setting
f.type of generator
5. Describe nursing interventions and expected outcomes that should be used to meet the three major goals of patient care.
Goals:
a.promote effective coping
b. prevent further infection
c.adherence to a self-care program
Nursing interventions:
a.Promoting effective coping:
recognize the patient as well as thew family emotional state and assist the patient to explore his or her feelings.
b.Prevent further infection:
change dressings regularly, inspect the insertion site for redness, swelling, soreness, or any unusual drainage.
c.Promoting Home and community based care:
teachings include the importance of periodic pacemaker monitoring, promoting safety, avoiding infection, and sources of electromagnetic interference.
Expected outcomes:
a.List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
b. Remains free of infection:has a normal temp and no redness or swelling on pacemaker insertion site
c. adherence to a self-care program: responds appropriately when queried about the signs and symptoms of infection
6. List assessment criteria that should be used to determine whether expected outcomes of care are achieved.
Expected outcomes:
a. Freedom from infection
b. Adherence to a self-care program
c. Maintenance of pacemaker function
Assessment criteria:
a. signs and symptoms of infection (temperature range, wbc count, redness or swelling etc)
b. patient adheres to monitoring schedule, identifies when to seek medical attention(as demonstrated in responses to signs and symptoms)
c. measurements and records of pulse rate at regular intervals and no abrupt changes in pulse rate or rhythm
yes because his cardiovascular system will undergo adjustment with his pacemaker.
2. a local infection at the entry site of leads for temporary pacing.
b. bleeding and hematoma
c. hemothorax from puncture of subclavian vein
3. local infection- history taking and several labolatory exams
4.the medications of patient
the type of catheter
the type of battery
post op care
the generator
the use of sedation and analgesia
5.
absence of infection
adherence to a self care program
effective coping and maintenance of pacemaker malfunction
preventing infection
promoting effective coping
promoting home and community based care
remains free of infection
adheres to a self care program
maintains pace maker function
has normal temperature
responds appropriately when queried about the signs and symptoms of infection
measures and records pulse rate at regular intervals
assessment
after a temporary or a permanent pacemaker is inserted
the patient's heart and rhythm are monitored by ecg the pacemaker settings are noted and compared with the ecg recordings to assess pacemaker functions.
pacemaker malfunction is detected by examining the pacemaker spike and its relationship to the surrounding ecg complexes,cardiac output and hemodynamic stability are assessed to identify the patients respond to pacing and the adequacy of pacing the appearance or increasing frequency of dysrythmia is observed and reported to the physician
CELY S. ANCHETA
ACTIVITY #1
1. Yes, pacemaker has the ability to sense and respond to heartbeat. In this case, it is due to the intrinsic ability of the heart that affects the beating of the pacemaker.
2. Complications include:
a. local infection on the site
b. formation of hematoma
c. bleeding
3. The most common post-operative complication is the displacement of the pacemaker electrode or the pacemaker itself. This can be prevented by limiting the activity of the patient and securing the pacemaker on place.
4.6 things about pacemaker:
a.type of generator
b.model of pacemaker
c.date and time of insertion
d.threshold stimulation
e.location of pulse generator
f. pacer setting
5. Goals:
a.free from infection
b.adherence to a self-care program
c.maintenance of pacemaker function
Nursing Interventions:
a.Check incision site for the presence of infection swelling, redness formation of hematoma, smell of discharge.
b.Educate patient and other family members on the proper care of the patient’s pacemaker, to monitor the heartrate, and seek doctor's advice if abnormality is present.
c.Advise patient to avoid exposures to any electronic devices like cellphones or microwaves as it may interfere with the pacemakers function.
Expected outcomes:
a. infection prevention
b. adherence of patient to self care
c. maintain the function of the pacemaker
6.list assessment criteria:
Expected outcomes:
a. free from infection
b. adherence to a self-care program
c. maintenance of pacemaker function
Assessment criteria:
a.WBC count is within normal range,temperature is also at normal range, and exhibits no redness or swelling on pacemaker insertion site.
b. Patient responds appropriately when queried about the signs and symptoms of infection. He identifies when to seek medical attention, adheres to monitoring schedule, describes appropriate methods to avoid EMI, and identifies activities that are safe and what to avoid.
c.Measures and records pulse at regular intervals, and experience no abrupt changes in pulse rate and rhythm.
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