CARE OF PATIENT ON

PACEMAKER
 WHAT IS A PACEMAKER?
- A cardiac pacemaker is an electronic
device that delivers direct stimulation of
the heart
 What is the purpose of a
pacemaker?
- the purpose of a pacemaker is to initiate
and maintain the heart rate when the
heart’s natural pacemaker is unable to do
so.
 Pacemaker Function
- Cardiac pacing refers to the ability of the
pacemaker to stimulate either the atrium,
the ventricles, or both heart chambers in
sequence and initiate electrical
depolarization and cardiac contraction.
- Cardiac pacing is evidenced on the ECG
by the presence of a “spike” or “pacing
artifact’
 Nursing Management
I. Maintain cardiac output
1. Record the following information after
insertion of the pacemaker
1.0 pacemaker manufacturer,
model, and lead type
1.1 operating mode (based on
ICHD code)
 1.2 programmed settings:
lower rate limit; upper rate limit;
AV delay; pacing threshold
2.Attach ECG electrodes for continuous
monitoring of heart rate and rhythm
3.Monitor vital signs every 15 minutes until
stable; then as directed.
4.Monitor urine output and level of
consciousness
5. Observe for the presence of dysrhyhtmias
6. Obtain 12-lead ECG daily as directed
II. Avoiding injury
1. chest x-ray
2. monitor for signs/symptoms of
hemothorax or pneumothorax
3. evaluate continually for bleeding
4. monitor for evidence of lead
migration and perforation of heart
5. provide an electrically safe
environment for patient
6.Be aware of hazards in the hospital
environment that can interfere with
pacemaker function or cause pacemaker
failure and/ or permanent pacemaker
damage.
7.Prevent possible accidental pacemaker
malfunction
8.Monitor for electrolyte imbalances,
hypoxia, and myocardial ischemia
III. Preventing infection
1. take temperature every 4 hours;
report elevation
2. observe incision site for s/s of local
infection
3. be alert to manifestation of
bacteremea
4. clean incision site using sterile
technique
5. monitor vein for evidence of phlebitis
6. evaluate patient’s complaints of
increasing tenderness and discomfort on
incision site
7. Administer antibiotic therapy as
prescribed
IV. Relieving anxiety
1. Explain procedures, treatments and
answer the patient’s questions with
concise explanation
2. Encourage patient to use coping
mechanisms to overcome anxiety
3. Monitor for unwarranted fears
expressed by the patient and provide
explanation to alleviate fear
4. Encourage patient to accept
responsibility of care
V. Minimizing the effect of immobility
1. bed rest for 24 to 48 hours and
immobilization of extremity nearest to
permanent or temporary
pacemaker lead implant (allows
stabilization of leads in the heart and
prevent dislodgement)
2. Promote pulmonary function
3. Promote venous return and prevent
stasis
4. restrict movement of the affected
extremity
5. Assist patients with activity of daily livings
as appropriate.
VI Relieving pain
1. Prepare patient for discomfort that
maybe experienced after pacemaker
implant or initiation of transcutaneous
pacing.
2. Administer analgesic as prescribed.
3. Offer back rubs to promote
relaxation.
4. Provide patient with diversional activities.
5. Evaluate effectiveness of pain-relieving
modalities.
VII. Maintaining a Positive Body Image
1. Encourage the patient to express
concerns regarding self-image and
pacer implants.
2. Reassure pt. that sexual activity and
modes of dressing will not altered by
pacemaker implantation.
3.Offer the pt. the opportunity to talk to
others who have had a pacemaker
implantation.
4.Encourage spouse of pt. or significant
other to discuss concerns of self image
with the patient.
VIII. Health teachings….
1. Teach your client on self care.
2. Promote safety.
3. Importance of periodic device
monitoring
4. Avoiding infection.
5. Avoiding EMI
6. Share information about activities
that are safe and those that may be
dangerous.