 Continuation

Nursing Intervention for clients with artificial pacemakers

 Wear loose-fitting clothing around the area of the

pacemaker.
 Observe for signs and symptoms of infection around
generator and leads- fever, heat, pain, skin impairment at
the implant site.
 Avoid contact sports
 Electrode may be displaced.

Cardioversion and Defibrillation

Cardioversion- is the synchronous application of an

electrical shock of short duration to the heart through the
use of chest paddles.
 It is done to convert cardiac dysrhythmia (other than
ventricular fibrillation) into a more hemodynamically
stable, sinus rhythm.
 Electric shoch is applied during the R wave; never on the T
wave

Defibrillation is unsynchronized passing of an electrical

shock of short duration through the heart to terminate
ventricular fibrillation or ventricular tachycardia without
pulse.
 Nursing Interventions During Cardioversion and
Defibrillation
 Place the patient in a flat, firm surface.
 Apply interface material (gel, paste, saline pads) to the
paddles.
 This is for better contact with the skin and to
prevent burns
 Grasp the paddles only by the insulated handles. To prevent
electrocution.
 Give command for personnel to STAND CLEAR of the client
and bed.
 Apply the chest paddles as follows: one oat the right of the
sternum; third ICS; and the other one on the left midaxillary,
fifth ICS.
 Push the discharge buttons in both paddles simultaneously.
 For defibrillation, release 200 to 360 watts/sec. (joules); for
cardioversion, lower energy is required.
 Defibrillation is done before initiating CPR if the client is
monitored.
 CPR is done before defibrillation if the client is unmonitored.

Cardiopulmonary Resuscitation (CPR)

 Indication
 Cardiopulmonary arrest or Clinical Death
(Breathlessness, Pulselessness)
  Crucial Time
 CPR is initiated within 4 to 6 minutes after the
arrest, to prevent brain death.
2 types of CPR
 Basic Life Support (BLS)
 Involves the use of the hands, mouth, and
the sincere desire to give the person a
second chance of life.
 Advanced Cardiac Life Support(ACLS)
 Involves BLS and the use of equipment,
emergency drugs and fluids to monitor the
client and stabilize his condition

CPR involves the CABD of Life Support

 C- Restore circulation
 A-Open airway
 B- restore breathing
 D- provide definitive treatment (ACLS)

Techniques of Basic Life Support

 Step I. Assess Level of Consciousness
 Shake the victim’s shoulder and ask “are you
okay?”
 If no response, place the client in supine position
on a firm surface
 Step II. Assess Circulation
 Check carotid pulse (adult) for 5 to 10 seconds;
brachial pulse for infant and child.
 No pulse, cardiac compressions are initiated.
 Step III. Initiate External Cardiac Compressions/External
Cardiac Massage
 Depress sternum with heels of both hands,one on top
of the other 1 ½ inch to 2 inches (adult); heel of one
hand to 1 ½ inches (child); 2 fingers ½ to 1 inch
(infant)
 Ratio for compressions and ventilation for adult, child,
and infant is 30:2. An equivalent of 100 compressions
per minute and 8 to 10 rescue breaths per minute.
 Hand position for adults and children is center of
chest (between nipples in children). For infants, use
the area just below the nipple line.
 Reassess the client after 2 cycles; if pulse is absent,
continue CPR.
 Recheck pulse every 3 to 4 minutes therafter.

 Step IV Open the Airway

 The tongue is the most common cause of airway
obstruction in the unconscious person.
 Use the head-tilt-chin lift and the jaw thrust methods
for opening and maintaining airway.
  Jaw thrust is recommended for clients with suspected
neck injury.
 Take 3 to 5 seconds to look, and feel for spontaneous
breathing.
 Step V. Initiate artificial Ventilation
 Mouth-to-mouth ventilation
 Mouth-to-nose ventilation
 Mouth-to-stoma ventilation
 Mouth-to-barrier ventilation
*Note: Give 2 initial breaths lasting for 1 ½ to 2 seconds. If no
rise and fall of the chest is observed, consider airway
obstruction.
 When to stop CPR?
 When the client is revived.
 When the EMS has been activated.
 When the rescuer is exhausted.
 When the client is dead.