Fundamental Concepts of Nursing Project

Fundamental Concepts of Nursing Project

Instructions/Descriptions

Fundamental Concepts of Nursing Project

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The Patient Teaching Guide

By Kimberly Williams, MSN, APRN FNP-c

Intended Audience: patients in need of a permanent implanted pacemaker.

Purpose of the Class: to discuss a procedure that all participants have been advised to have for symptom management and relief.

Set up of Presentation: group discussion with presentation of material by a registered nurse to a group of patients in need of a permanent implanted pacemaker with the assistance of a brochure.

Objectives (3)

1. Indications for pacemaker placement
2. What to expect with pacemaker implantation
3. Complications of pacemaker placement

Presentation

Presentation style: group with brochure (brochure included)

Procedure: Pacemaker Placement (AICD with Defibrillator)

Definition of procedure: a pacemaker is an electrical device that stimulates the heart with electrical impulses to maintain or restore a normal heartbeat. This impulse is generated by an artificial external device.

Reason for procedure: Most common indications for permanent pacemaker implantation are conditions that affect the electrical conduction of the heart leading to syncope or fainting spells, after the acute phase of a myocardial infarction (MI), after a heart transplant, for patients with congenital heart disease, or to pace the heart to detect and terminate bradycardia or tachycardia.

Preparation for the procedure: Your medical team may recommend various tests to confirm that you’ll benefit from having a pacemaker such as EKG, stress test, echocardiogram, and even a Holter monitor. moving forward after its deemed necessary for pacemaker implantation your medical team will give further instructions on eating, drinking, and even which medications to take and not to take and even a prescribed soap to cleanse the area for pacemaker implantation.

Procedure – what happens: the day of your procedure you will arrive at the facility at the specified time, where you may have to complete forms and signs consent forms to have the procedure done. A nurse will insert an intravenous catheter into a vein for medication administration. The pacemaker insertion site may be cleaned and prepped prior to insertion. You may be given a sedative to help you relax before the procedure. The pacemaker insertion site will be numbed and the electrophysiologist will implant tiny wires, known as electrodes or leads near your collar bone. These electrodes will be guided through the veins to your heart. Once the electrodes have been delivered to the heart, your electrophysiologist will place them inside your heart where they can deliver electrical impulses to the muscles of the upper and or lower heart chambers. The pacemaker’s battery and the circuits that create the electrical impulses (the pulse generator) will be implanted below your skin, not far from your collar bone. And the insertion site closed sometimes with an adhesive glue, and a pressure dressing is applied to prevent hematoma formation. A sling may be applied to the arm.

Recovery/Follow-up: your medical team may want to monitor you overnight following the implantation of the pacemaker, so your electrophysiologists can program your pacemaker to fit your needs and monitor it’s functioning. You may be required to have regular visits until he/she is certain the pacemaker is functioning as it should and your body has adjusted to it.

Complications: the most common complications to permanent pacemaker implantation are:

Hematoma- a collection of blood under the skin

Lead dislodgement – one of the tiny wires comes a loose from the heart

Infection – insertion site infection

Lead perforation – is rare but can lead to fluid around heart, lung collapse, or even death.

Dysrhythmias – irregular heartbeats can occur when the pacemaker does not sense or pick up the internal impulse. Ventricular tachycardia or ventricular fibrillation may occur and can be life threatening.

Safety and comfort measures: for safety reasons you should notify your doctors, dentists and emergency workers that you have a pacemaker and show them your medical device ID card. Your medical team may direct you on how much and how strenuous you can walk, exercise and bathe, you should avoid wearing tight clothing that could irritate the skin around your implant. You should also avoid rubbing your implant or the surrounding chest area. Avoid magnets and strong electrical fields. Your doctor may recommend that you take and record your pulse to gauge your heart rate. Your medical team may advise you on when to contact your medical provider in such as heart rate > 100 beats per minute, or sudden drops in heart rate, irregular heartbeats or if you notice a sudden slowing of your heart. Other concerns include difficulty breathing, weight gain with leg and ankle swelling, and feeling faint or having dizzy spells. Your medical team may also recommend that you carry your pacemaker ID card in your wallet or purse.

Fundamental Concepts of Nursing Project

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