What rhythm am I?
What's wrong with me?
How do you fix me?
Nursing care of Pacemaker
100
Third Degree Heart Block
100
Failure to sense (undersensing)
Pacer not "sensing" recognizing the underlying rhythm and firing anyway/firing inappropriately
100
Undersensing=
- Increase sensitivity (lower the fence = lower the number)
- Change to synchronous mode (turn on sensing)
100
What type of pacemaker requires strict bedrest?
Transvenous pacer that is just floated in.
200
AV paced or atrial ventricular pacing
200
Failure to capture
Pacer is sending an impulse and spike appears, but the heart doesn't respond with a QRS
200
Failure to Capture=
- Increase milliamps
- Lead out of place
- Replace electrolytes
200
How many RNs are required to change the dressing for a transvenous (floated) pacemaker.
Because the lead is not screwed in and to avoid accidental dislodgement, it requires 2 RNs to change the dressing
300
V-paced or ventricular pacing
300
Failure to fire
The heart has no intrinsic rhythm, but the pacer does not fire to initiate a QRS (no pacer spike)
300
Oversensing
- Decrease sensitivity (increase number = increase fence height)
300
Name two things the magnet is used for: one for a pacemaker and one for an ICD
Pacemaker: Changes to asynchronous mode (AOO, VOO, DOO)
ICD: Turns off shocking, turns off arrhythmia detection
400
A-paced or atrial pacing
400
Nothing is wrong with me, trick question!! This is appropriate AV pacing.
400
DOUBLE JEOPARDY:
DO A HAPPY DANCE
Yay!!
400
You see the rhythm above and patient is unresponsive, but HAS a pulse. What button on the pacer are you going to push to fix it?
DOO button at the top of the pacemaker
500
Biventricular Pacing
500
Oversensing
The pacemaker did not recognize that a QRS was dropped and did not fire. It was potentially thinking that the P wave was the patient's intrinsic QRS
500
You see the rhythm below and patient unresponsive, no pulse. You hooked up the pacemaker, but the rhythm persists. What do you do next?
Call code blue, Start CPR, second rescuer hook up Zoll and defibrillate.
500
What signs/symptoms are you monitoring for when epicardial wires are removed?
Signs of tamponade - pulses paradoxus (blood pressure decreases 20 mmHg with inspiration), Beck Triad (hypotension, increase JVD, diminished heart sounds)