Med Side Effects
This med causes prolonged QT intervals, hypotension, CHF, liver function test abnormalities, and AV blocks/dysrhythmias
What is Amiodarone
When the pacemaker fires it should be followed by what-
What is a contraction (QRS complex/Depolarization/Capture also works)
Go to drug for symptomatic bradycardic rhythms:
What is Atropine
Non pharmacological care for non-emergent SVT
What are Vagal maneuvers (Valsalva maneuvers ae nursing interventions - holding your breath and bearing down and blowing through a straw/syringe)
What rhythms can be cardioverted?
Afib, A flutter, SVT, Vtach w pulses
This med can cause bronchospasms, flushing, CHF, dizziness, heart block, hypotension, and bradycardia
What is metoprolol, propranolol, sotalol (beta-blockers)
Indications for a pacemaker-
What is bradycardic rhythms and heart(AV) blocks
Atropine action:
What is an anticholinergic effect - blocks the vagus nerve action and therefore increases heart rate
These medications (4) treat atrial rhythms that are too fast:
calcium channel blockers, beta blockers, adenosine, and amiodarone
When is defibrillation used?
Pulseless Vtach and VFib
(priority intervention -- over CPR unless the room lacks crash cart/monitor)
This med often causes neuro symptoms like agitation and confusion, as well was hypotension, arrhythmias, and cardiac arrest
What is Lidocaine
What are the post-op Pacemaker surgery complications?
Bleeding
Infection
What is electrical vs mechanical capture?
Mechanical capture - making sure the patient has a pulse
These medications (2) treat ventricular rhythms that are too fast:
note: Amiodarone can also treat Afib and Aflutter
This is synchronized to the R wave in the QRS complex
What is Cardioversion
This med can cause dry mouth, blurred vision, dizziness, nausea, and tachycardia
Type of pacemaker for emergent pacing -
What is a temporary, external Transcutaneous pacemaker
What are the indications for an ICD:
Pt has a history of lethal dysrhythmias- Vtach, Vfib, and extreme tachycardias
Nursing considerations for Amiodarone:
Must use filter tubing, must be on cardiac monitor for IV therapy and initiation of po therapy, and can cause potentially lethal dysrhythmias due to prolonged QT intervals
This electrical therapy is asynchronized
What is Defibrillation
What is Adenosine
Complications of Pacemakers, non-post-op
Poor perfusion (Myocardial perforation)
Malfunction/Loss of capture leading to baseline rhythm (Caused by dislodgement of pace wire or inappropriate pacing/sensing)
Irritation of heart (Pace wire irritates the ventricle)
Stimulation of Diaphragm (Hiccups)
What is an ICD and what does it do?
It is a long term implanted device of smaller size and technology to a pacemaker and it delivers an electrical shock to a patient's heart to eliminate and convert out of lethal dysthymias when detects
Implementation for Adenosine
What is: (Drug of choice for SVT)
Administer as IVP at a site closest to heart - central line or AC
Rapid push w 20 ml NSS flush after
Raise arm following push
Have code cart in room just in case
Pt MUST be on monitor
Half life of 10 seconds - given quickly and in heart as fast as possible
What are the steps to Cardioversion?
Explain procedure to pt and obtain informed consent if it is not an emergent treatment
Move crash cart to bedside
Place quick combo pads on pt
Give sedation and pain meds as ordered
Select energy to be applied
Press sync button on monitor
Press charge button
When charged call all clear at least twice
Press and hold shock button until charge is delivered
Monitor pt for rhythm change