Complex Exam 2 Study Guide

Pacemaker Indications * Answer-arrhythmia or conduction defect compromise electrical system and hemodynamic response ex.) heart block Pacemaker Teaching * Answer-1. carry pacemaker ID care that has brand and model of pacemaker, date of insertion, implanting physician, and manufacturer contact info 2. take pulse once daily after awakening 3. report pulse 5 beats/minute different than programed setting 4. be mindful of return of symptom you experienced before pacemaker implantation 5. follow-up to avoid battery depletion and no replacement Pacemaker Capture * Answer-indicates depolarization of atria or ventricle in response to pacing stimulus Pacing Threshold * Answer-minimal amount of voltage required from pacemaker to initiate consistent capture Pacemaker: *Failure to Discharge* * Answer-problem: no evidence of pacing stimulus, patient's HR below programed rate causes: *battery depletion*, pulse generator failure, circuit failure, loos cable connection intervene: replace battery or generator, check all connections for tightness Pacemaker: *Failure to Capture* * Answer-problem: pacing stimulus not followed by ECG evidence of depolarization causes: *lead dislodgment*, broken cables, incompatible cables, output settings (mA) too low, perforation, increase in pacing threshold related to medication or metabolic changes intervene: review chest film, turn patient to left lateral decubitus position until lead can be replaced, connect wire directly to eliminate cable problem, replace cables, ensure tight connection, review ECG for perforation, review lab results for metabolic alterations and medications Pacemaker: *Oversensing* * Answer-definition: device detects noncardiac electrical events and interprets them as depolarization causes: oversensitive settings, device detecting tall T waves and interpreting them as R waves intervene: reduce sensitivity, increase ventricular refractor period beyond T waves