Pacemakers
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Included In This Lesson
Study Tools For Pacemakers
Electrical Conduction of The Heart (Cheatsheet)
EKG Electrical vs Mechanical Worksheet (Cheatsheet)
Parts of EKG waveform (Image)
Implanted Pacemaker and Cardiac Pacemaker Leads (Image)
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Outline
Overview
- Pacemakers
- On or implanted in chest
- Correct electrical issues in heart
Nursing Points
General
- Need for pacemaker
- Sick sinus syndrome–>SA node damaged–>alternating slow and fast heart rates
- Poor electrical signals in heart
- Irregular rhythm
- Slow rate
- Electrical signals
- Make heart beat–>normal 60-100 beats/minute
- Control rate and rhythm
- Ensure contraction of ventricles–>pump blood through vessels
- Temporary or permanent placement
- Types
- Single chamber
- One wire
- Dual-chamber
- Two wires
- Biventricular
- Three wires
- Rate-responsive
- Sensors to detect patient’s need
- Single chamber
Assessment
- Assess for symptoms of pacemaker malfunction or misplacement
- Dizziness
- Syncope
- Confusion
- Shortness of breath
- Intolerance of excercise
- Pain or swelling at site
- Telemetry and Electrocardiography (EKG)
- Pacer spikes followed by QRS–>good
- Watch for irregular heart beats–>bad
- Pacemaker syndrome–>atria and ventricles contracting at the same time–>ineffective
Therapeutic Management
- XRAY confirmation of placement
- Interrogation as needed
- Event of cardiac arrest–>avoid defibrillator patch placement over pacemaker
- End of life–>deactivation
- Patient request
- Death of DNR patient
Nursing Concepts
- EKG Rhythms
- Determine need for pacemaker
- Monitor for pacer spikes
- Monitor for pacemaker malfunction
- Patient Education
- What must be avoided with the pacemaker
- Importance of battery replacement and interrogation as needed
- Perfusion
- Provides electrical signals through heart to pump blood and perfuse the body with blood
Patient Education
- Avoid devices that may interfere
- Keep dry two weeks after placement
- Notify providers of pacemaker
- Notify doctor of changes
- Interrogation as needed for malfunction concerns
- Replace batteries as instructed–>every 5-10 years
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Transcript
Hey guys! Welcome to the lesson on pacemakers where we will explore what a pacemaker is, why a patient might need one, and what they do in the body.
Pacemakers are used to fix electrical issues in the heart. This picture shows a heart and the electrical nodes within that control the heart rate and rhythm. Pacemakers may be placed on the chest, or implanted under the skin in the chest. They might be temporary or permanent, depending on the patient’s condition. The patient must have an X-ray to ensure that the pacemaker is in the correct place. Next let’s explore the use of pacemakers in more detail.
Okay so first let’s review the electrical signals of the heart. The electrical signals of the heart make the heart beat by setting the pace for the rate and rhythm, and making sure that the ventricles contract to pump blood through the vessels of the body. Without the signals, the body would not be perfused with blood. This picture shows where each part of the electrical system is in the heart. The atria are located on the top, and the ventricles below. The SA node is the natural pacemaker of the heart so first it will send the signal through the atria making the atria contract first. Next, the AV node signal is going to go through the bundle of his into the purkinje fibers. This allows the ventricles to contract after the atria.
So, a patient may have damage to the SA node of the heart. If the natural pacemaker of the heart is damaged, the signals are out of whack causing alternating slow and fast heart rates. A pacemaker may be implanted in any situation where there are poor electrical signals in the heart, irregular rhythms, heart rates that are too slow, or ineffective pumping like in heart failure.
There are different types of pacemakers that the doctor may choose to implant in the patient’s chest depending on what the issue is with their heart. The single chamber pacemaker has one wire and is placed in the patient that is having bradycardia, but the chambers are pumping as they should be. In this case the SA node is not providing the electrical impulses at the necessary rate to effectively perfuse the body. The dual-chamber has two wires, one is placed in the atrium and one in the ventricle to treat slow heart rates, heart block, or atrial fibrillation. So in this case, the AV node is faulty as well and needs some help on providing signals to the ventricles. Biventricular pacemakers are used for patients with heart failure where the ventricles aren’t working together. It has three wires that are placed to help the ventricles pump at the same time. Now, some pacemakers respond based on the signals present in the heart and give signals as needed. These are called rate-responsive pacemakers.
So, when you’re taking care of a patient with a pacemaker, it’s important to ensure that it’s functioning properly. If your patient’s experiencing dizziness, syncope, confusion, shortness of breath, intolerance of exercise, or pain and swelling at the site, you should immediately notify the doctor. Interrogation of the pacemaker may be done by a professional using a device to check the settings.
The patient with a pacemaker is probably going to be monitored by EKG and telemetry per the doctor’s order when admitted to the hospital. You will notice pacer spikes on the rhythm strip. The location of the spike depends on where the pacemaker leads are located in the heart. A spike before the QRS is called ventricular pacing, and a spike before the p wave is called atrial pacing. Dual chamber pacing may show one or both. If your patient isn’t showing a spike at all, don’t worry as long as the rate and rhythm are appropriate. If you observe irregular rate and rhythms, the doctor should be notified because the pacemaker may need to be interrogated. Pacemaker syndrome may occur after placement where the atria and ventricles are contracting at the same time. This is very ineffective at pumping blood through the body, and needs to be addressed.
If your patient has a pacemaker, and their heart stops beating, you will use a defibrillator to shock the heart in attempt to restart it. It’s very important to avoid defibrillator patch placement over the pacemaker to avoid damage. When a patient is at the end of life, say they are going on hospice, they or their family may request to have the pacemaker deactivated to avoid prolonged life. If you are caring for a patient that is a DNR which means “do not resuscitate”, their pacemaker must be deactivated with a big magnet over their chest when they pass away to stop the electrical signals.
Patient education is crucial after the placement of a pacemaker to ensure that it isn’t damaged. The patient must avoid devices that interfere with the pacemaker device such as MRIs. After placement, the patient must keep the skin dry for two weeks. Provider notification ensures that inappropriate tests aren’t ordered that may damage the device. Any strange signs and symptoms such as syncope, dizziness, or shortness of breath should immediately be shared with the doctor. If the pacemaker needs interrogated, this will be done by a representative of the pacemaker company that makes them, not the doctor or nurse. Batteries must be replaced about every 5-10 years depending on the device.
The nursing concepts for pacemakers include EKG rhythms, patient education, and perfusion.
Let’s review the key points to know about pacemakers. So, pacemakers are placed in patients with sick sinus syndrome where the SA node isn’t sending the heart the correct signal to contract, irregular rhythm, slow heart rates and heart failure. The purpose of the pacemaker is to provide the electrical signals to make the chambers contract in the right order and timing. Pacemakers make the heart beat to perfuse the body with blood. Make sure you are monitoring telemetry and EKG strips, and assessing for signs of pacemaker malfunction such as dizziness, syncope, or irregular rhythm. When caring for a dying patient with a pacemaker, you should address need to deactivate it with the doctor, patient, and family. Patients must be educated on the importance of changing the batteries as instructed, getting the pacemaker interrogated as needed, and avoiding certain electronics and scans such as MRIs.
I hope you got a good grasp on what pacemakers are used for and what to consider with your patient’s that have them. Please check out the lessons titled Cardiac Anatomy and Electrical A&P of the Heart to help you better grasp how the heart works. Thanks for listening, now go out and be your best self today, and as always, happy nursing!
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Environmental Health Assessment Nursing Mnemonic (I PREPARE)
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Evaluation of Irregular Moles Nursing Mnemonic (ABCDE)
Exercise Guidelines Nursing Mnemonic (FIT)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Fetal Distress Interventions Nursing Mnemonic (Stop MOAN)
Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fire Safety 1 Nursing Mnemonic (PASS)
Fire Safety 2 Nursing Mnemonic (RACE)
Flu Symptoms Nursing Mnemonic (FACTS)
Fractures
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Global Symptoms for Brain Tumors Nursing Mnemonic (HAS)
Gluten Free Diet Nursing Mnemonic (BROW)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hemodynamics
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hiatal Hernia Symptoms Nursing Mnemonic (Her Belly Really Hurts Following Dinner)
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
High Risk Behavior Nursing Mnemonic (HEADSS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)