Si Tim Specific Content Teachers Students AV Evaluation
n e objective activity activity aid
o s
1 1mt introduce the INTRODUCTION Student Students
teacher are
topic Pacemakers are the electrode devices that can be used to initiate
introduce listening
the heartbeat when the hearts intrinsic electrical system cannot the topic
effectively generate a rate adequate to support cardiac output.
define DEFINITION
2 1mt
pacemaker Pacemakers is an electronic device used to pace the heart when Student Students what is
teacher are pacemaker
the normal conduction pathway is damaged or diseased.
defined actively
pacemaker listening
enlist the COMPONENTS OF PACEMAKER
3 1mt
components Pulse generator
Pacemaker electrodes
4 2mt HOW PACEMAKER WORKS
describe the
Student Students How does
working of A pacemaker consists of a battery, a computerized generator and teacher are the
pacemaker wires with sensors at their tips (called as electrodes). The battery describing taking pacemaker
the notes work
powers the generator and both are surrounded by a thin metal working of
box. The wires connect the generator to the heart. pacemaker
A pacemaker helps monitor and control the heartbeat. The
electrodes detect heart’s electrical activity and send data through
the wires to the computer in the generator. If heart rhythm is
abnormal, the computer will direct the generator to send
electrical pulses to heart. The pulses travel through the wires to
reach the heart.
TYPES
enlist the a) Permanent pacemaker
5 1mt
types b) Temporary pacemaker
s Student Students What are the
teacher are types of
enlisted the observin pacemaker
PERMANENT PACEMAKER
types g
describe the o Implanted totally in the body.
permanent o Power source is implanted subcutaneously usually over
6 10m
t pacemaker the pectoral muscle on the patient non dominant side. Student Students What is a
teacher contribut permanent
describes e points pacemaker
TYPES OF PERMANENT PACEMAKER the
permanent
Single-chamber pacemaker. pacemaker
In this type, only one pacing lead is placed into a chamber of the
heart, either the atrium or the ventricle
Dual-chamber pacemaker.
o Wires are placed in two chambers of the heart
o One lead pace the atrium and one paces the ventricle
o Closely resembles the natural pacing of the heart.
Rate-responsive pacemaker.
It has sensors that detect changes in the patient's physical
activity and automatically adjust the pacing rate to fulfil the
body's metabolic needs.
INDICATION OF PERMANENT PACEMAKER
THERAPY
Chronic atrial fibrillation with slow ventricular
response Hypersensitive carotid sinus syndrome
Fibrosis or sclerotic changes of cardiac conduction
system
Sick sinus syndrome Tachyarrhythmia Third
degree AV block
describe the
temporary TEMPORARY PACEMAKER
10m pacemaker It is one that has the power source outside the body.
t Student Students What is
teacher are temporary
TYPES OF TEMPORARY PACEMAKER describes listening pace maker
the
Transvenous invasive pacemaker (endocardial) temporary
It consists of lead or leads that are threaded transvenously to the pacemaker
right atrium and or right ventricle and attached to external power
source.
Transthoracic invasive pacing (Epicardial pacing)
It is achieved by attaching an atrial and ventricle and attached to
epicardium during heart surgery. The leads are passed through
the chest wall and attached to the external power source.
Trans cutaneous pacemaker (Non-invasive pacing)
It is used to provide adequate heart rate and rhythm to the
patient in and emergency situation.
INDICATION OF TEMPORARY PACE MAKER
Maintenance of adequate heart rate and rhythm
during special circumstances such as surgery and
postoperative recovery, cardiac catheterization or
coronary angioplasty.
Before implantation of a permanent pacemaker.
As prophylaxis after open heart surgery.
Acute anterior MI with second degree or third degree
AV block or bundle branch block.
Acute inferior MI with symptomatic bradycardia and
explain the AV block
nursing
management NURSING MANAGEMAENT
Preoperative care
Financial
10m
t Explain the procedure, type and technique of pacemaker Student Students which are
to the patient teacher are the nursing
explain the actively management
Explain Cost of the procedure and Hospital stay. nursing listening s
manageme
Psychological
nt
Explain the Process of the pacemaker insertion.
Reassure the patient
Physical
Obtain written consent from the patient and from nearest
relative
Remove dentures, jewellery and contact lens.
Clean and shave the area.
Check vital signs: temperature, BP, pulse and respiration
Intraoperative care
Check serology: HIV, HbsAg, HCV and others
Start an IV line with 5% Dextrose solution or normal
saline solution.
Check the battery in pulse generator
Prepare the emergency cart, the defibrillator and
jelly, and the ECG monitor
Set up all equipment for the insertion of the
pacemaker
The nurse should know about the pacemaker
generator including the power switch, indicator light
for pacing and sensing, stimulus output dial,
sensitivity dial, and their proper settings.
Assist the doctor and the scrub nurse during the
procedure step by step
Observe vital signs and observe ECG monitor
carefully for arrhythmias and other complications.
Post-operative care
Receive the patient
Keep the patient in comfort position
Record the pacing parameters.
-Receiving time
patient’s heart rate
Other routine care
Immobilize the affected part and keep in supine
position but allow the movement of finger and ankle
joint.
Monitor heart rate and rhythm.
Monitor vital signs and level of consciousness of
patient.
Prevent infection.
list out the Take ECG and X-ray chest.
patient and Watch for complications
family
teaching
PATIENT AND FAMILY TEACHING
Maintain follow up care with a physician to check the
pacemaker site and begin regular pacemaker function
10m
checks.
t Student Students What are the
Watch for signs of infection at incision site redness, teacher are patient and
listed out listening family
swelling dressing.
the patient teaching
Keep incision dry for 1 week after implantation. and family
teaching
Avoid lifting operative side arm above shoulder
level until approved by care provider.
Avoid direct blows to generators or to large magnets
such as MRI scanner. These devices can reprogram a
pacemaker.
enlist Microwave oven are safe to use and do not threaten
complication pacemaker function.
s The patient should be taught how to take the pulse
Carry pacemaker information card at all the times.
COMPLICATIONS
Hematoma
Pneumothorax
Failure to sense or capture
5mt Student Students What are the
Perforation of atrial or ventricle septum teacher are complicatio
enlist the taking ns
explain Ventricular atrophy and tachycardia
complicatio notes
nursing Movement or dislocation of lead n
diagnosis Cardiac perforation
NURSING DIAGNOSIS
Acute pain related to insertion site and prescribed post
procedure immobilization.
5mt Disturbed self-concept related to perceived loss of health and
Student Students Which are
dependence on pacemaker.
teacher are the nursing
Impaired physical mobility related to incisional site pain, explain the listening diagnosis
nursing
activity restrictions.
diagnosis
Risk for infection related to operative site.
Risk for ineffective therapeutic regimen management related
to insufficient knowledge of activity restrictions,
precautions.
CONCLUSION
pacemaker is an electronic device that provides repetitive
electrical stimuli to heart muscle when the patient’s intrinsic
pacemaker fails to provide perfusing rhythm.
2mt
BILIOGRAPHY
Smeltzer Suzanne C, Barebrenda G, Hinkle Janice L,
Cheever Kerry H. Textbook of medical surgical
nursing, 12th ed. Newdelhi: Lippincot wolter’s
kluwer; p.113-114(vol-1)
Lewis Sharan mantik, Heitkemper Margaret Mclean,
Shannon Ruff Dirksen,Obrien Patrical, Giddens Jean
Foret, Bucher Linda. Medical surgical nursing. 6th
ed.Mosby; p.874-78
Best practices A guide to excellence in nursing care.
lippincott William and wikins. P.252-53.
Pamela J Bradshaw, Paul Stobie ,Matthew W
Knuiman, Thomas G Briffa, Michael S T Hobbs.
Trends in the incidence and prevalence of cardiac
pacemaker insertions in an ageing population. 2014;
1(1)
www.nhlbi.nih.gov/health/healthtopics/topics/pace/h
owdoes
1
3
1
4
1
5
1
6
