Question

Case Study, Chapter 26, Management of Patients With Dysrhythmias and Conduction Problems

1. Janis White, 21 years of age, is a female patient who received a permanent atrioventricular pacemaker for the diagnosis of sick sinus rhythm, a disorder that leads to periods of tachycardia and periods of extreme bradycardia or sinus arrest. The nurse received the end-of-shift report and arrives at Ms. White’s room where she assesses the patient’s incision dressing on the upper left chest and it is dry. The patient’s left arm is edematous and ecchymotic and twice the size of the other arm. The patient states that her left arm feels numb and tingling. The distal pulses are present and at baseline. None of the findings were noted in the end-of-shift report. (Learning Objective 6)

1. What nursing management should the nurse provide immediately?

2. Explain the general care of the patient after receiving an implanted pacemaker.

2. The nurse on the telemetry unit responds to the cardiac monitor alarm on a patient recovering from a myocardial infarction. Upon entering the room, the nurse notes that the rhythm on the monitor appears to be ventricular tachycardia. (Learning Objective 7)

1. What action should the nurse take first?

2. The nurse notes the patient has no pulse, and tells someone to get the code cart and another to call the hospital’s code team. Upon arrival of the code cart, the nurse prepares the defibrillator for use. At what energy level does the nurse set the biphasic defibrillator for the first shock?

3. After defibrillation, the nurse assesses the patient, finds him pulseless, and initiates cardiopulmonary resuscitation. The code team has arrived, and epinephrine is administered. What is the rationale for this medication in this emergency situation?

4. What is the difference between monophasic and biphasic defibrillators?

Answer 1

Ans: Inform the doctor immediately.check the vitals and patient have no respond ,check the ABC.then give CPR 30:2 ratio. Monitor for leads dislodgement,seen as ECG changes or

hiccups if diaphragm is being paced.- monitor ECG for loss of sensing,loss of capture,or failure to pace .-provide pain mediacation and assess insertion site for bleeding and infection.

Educating the patient on the proper use and maintenance of the pacemaker.

  

What are the general care of implantation of pacemaker?

Ans: 1. Follow doctor advise

2. Wound care dressing you have to follow as a instruction.

3. Take your temperature every day and check your incision for signs of infection

4. Learn take your own pulse

5. Before you have any medicine tell them health care provides

6. You will be given ID card that has information about your pacemaker

7 . Keep your cell phone away from your pacemaker

What action should the nurse take first?

1 see the leads first make proper position

2 sensor based pacing relies on sensors(eh respiratory rate body motion)

3 To provide input to the pacemaker to adjust the paced heart rate approximately for the level of metabolic demand

If increase tachycardia development of arterial fibirillaton or flutter in patient with dual chamber pacemaker leads to pacemaker mediated tachycardia..arterial rhythm is sensed by the arterial lead,which triggers ventricular pacing at the maximal programmed rate.

Biphasic defibrillator for the first shock?

The defibrillator is turned on and charges to 120 joules-- not the 200 joules you expect for a first shock.but it's not malfunctioning.this equipment is a biphasic model with a default energy level of 120 joules for the first shock; 200 joules is the maximum it can deliver.

Epinephrine and what is the ratonal for this medication in this emergency situation?

The medication is used in emergencies to treat very serious allergic reactions to insect stings/ bites ,food,drugs,other substances .Epinephrine acts quickly to improve breathing ,stimulate the heart ,raise a dropping blood pressure,reverse hives and reduce swelling of the face,lips,and throat.

What is the difference between monophasic and biphasic defibrillator?

Monophasic : Defibrillator have long used a monophasic wave form,where current flows in one direction from one electrode to the other,stopping the heart momentarily,and allowing the basic sinus rhythm to be restored.

Biphasic defibrillator: deliver current in two directions.in the first phase ,the current moves from one paddle to the other as with monophasic defibrillators.During the second phase ,the current flow reverses direction.