Pacemaker powerpoint presentation med surg

pacemaker - artificial pump to the heart, this contained definition, components,working, types, indication, methods of pacaing, temporary and permanent pacemaker, signs of failure of pacemaker , medical and nursing management of patient with pacemaker.

1. PACEMAKER Submitted to : - Mrs. Mamta Toppo Associate Professor, College of nursing RIMS, Ranchi Submitted by : Muskan Kumari Roll no. – 8 Basic B.sc nursing 3 rd year ( 17-21) College of nursing RIMS, Ranchi

2. CONTENTS Introduction Definition Components of pacemaker How pacemaker works ? Types of pacemaker Indications of permanent pacemaker Indications of temporary pacemaker Methods of pacing Pacing Mode Causes for a pacemaker failure Signs of pacemaker failure Nursing diagnosis Nursing management Complications Care of implanted pacemaker Patient and family teaching Summary Evaluation New Research done on it Reference Bibliography

3. INTRODUCTION Pacemaker are the electrode devices that can be used to initiate the heartbeat when the hearts intrinsic electrical system cannot effectively generate a rate adequate to support cardiac output.

4. DEFINITION Pacemaker is an electronic device used to pace the heart when the normal conduction pathway is damaged or diseased.

5. COMPONENTS OF PACEMAKER Pulse generator Pacemaker electrodes

6. HOW PACEMAKER WORKS ? A pacemaker consists of a battery, a computerized generator and wires with sensors at their tips ( called as electrodes ). The battery powers the generator and both are surrounded by a thin metal box. The wires connect the generator to the heart. 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.

7. HOW PACEMAKER WORKS ?

8. TYPES OF PACEMAKER Permanent pacemaker Temporary pacemaker

9. PERMANENT PACEMAKER It is implanted totally in the body. The power source is implanted subcutaneously usually over the pectoral muscle on the patient non dominant side.

10. TYPES OF PERMANENT PACEMAKER Single-chamber 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 :- Wires are placed in two chambers of the heart. One lead paces the atrium and one paces the ventricle. It 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 fulfill the body’s metabolic needs.

11. 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

12. TEMPORARY PACEMAKER It is one that has the power source outside the body. It can be used temporarily, either supportively or prophylactically , until the condition responsible for the rate or conduction disturbance resolves.

13. TYPES OF TEMPORARY PACEMAKER Transvenous invasive pacemaker :- It consists of lead or leads that are threaded transvenously to the right atrium and or right ventricle and attached to external power source. Transthoracic invasive 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 cutanoeus pacemaker :- It is used to provide adequate heart rate and rhythm to the patient in and emergency situation.

14. INDICATION OF TEMPORARY PACEMAKER THERAPY 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.

15. METHODS OF PACING TRANSVENOUS PACEMAKERS :- It involves threading an electrode catheter through a vein into the right atrium or right ventricle. Five different veins can be used . - Antecubital approach - Femoral approach - Subclavian - Internal jugular - External jugular

16. 2. EPICARDIAC PACEMAKERS In this case, the wires are attached to the endocardium and are brought through a surgical incision in the thorax. These wires are connected to an external pulse generator. Commonly seen after cardiac surgery.

17. 3. TRANSCUTANEOUS PACING TRANSCUTANEOUS PACING is a temporary means of pacing a patient’s heart during an emergency and stabilizing the patient until a more permanent means of pacing is achieved. The most common indication for transcutaneous pacing is an abnormally slow heart rate.

18. 4. TRANSTHORACIC PACING It is placed in emergency via a long needle, using a subxyphoid approach. The wire is then placed directly into the right ventricle.

19. PACING MODE The pacing mode is described with a 4 – or 5 – letter code ( eg ., DDDR ), in which the first position identifies the chamber paced ( A for atrium, V for ventricle, D for dual/both ), the second position indicates the chamber sensed, the third position denotes the device response to sensed events ( I for inhibit, T for trigger, or D for dual ), the fourth position indicates whether rate response is on, and the fifth position ( when used ), indicates whether multisite pacing is employed in the atrium ( A ), ventricle ( V ), or both ( D ). In response to a sensed intracardiac signal, a pacemaker may inhibit output, trigger output, or pace in different chamber after a timed delay. This function is governed by the programmed pacing mode.

20. COMMON PACING MODES

21. CAUSES FOR A PACEMAKER FAILURE Battery depletion Loose or broken wire between the pacemaker and the heart Electronic circuit failure resulting from a break in wire insulation or a fracture in the wire Electrolyte abnormality ( such as high potassium in the blood ) A pacemaker lead getting pulled out of position A change in your condition that needs pacemaker reprogramming

22. SIGNS OF PACEMAKER FAILURE Dizziness, lightheadedness Fainting or loss of consciousness Palpitations Difficulty in breathing Slow or fast heart rate, or a combination of both Constant twitching of muscles in the chest or abdomen Frequent hiccups

23. NURSING DIAGNOSIS Acute pain related to insertion site and prescribed post procedure immobilization. Impaired physical mobility related to incisional site pain, activity restrictions. Risk for infection related to operative site. Risk for ineffective therapeutic regimen management related to insufficient knowledge of activity restrictions, precautions.

24. NURSING MANAGEMENT Preoperative care Explain the procedure, type and technique of pacemaker to the patient. Explain the cost of the procedure and hospital stay. Explain the process of the pacemaker insertion. Reassure the patient. Obtain written consent from the patient and from nearest relative. Remove the dentures, jewellery and contact lens. C lean and shave the area. Check vital signs : temperature, BP, pulse and respiration.

25. Intra-operative-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.

26. 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 vital signs, heart rate and rhythm. Prevent infection and watch for complications. Take ECG and X-ray of chest.

27. COMPLICATIONS Hematoma Pneumothorax Cardiac perforation Ventricular atrophy and tachycardia Infection Movement or dislocation of lead Venous occlusion

28. CARE OF IMPLANTED PACEMAKER Follow your doctor’s directions carefully for wound care. If there is a dressing, ask whether you should remove it or keep it until your next visit. Take your temperature everyday and check your incision for signs of infection. Keep your cell phone away from your pacemaker. Don’t carry the phone in your shirt pocket over the pacemaker. Before you have any treatment, tell all health care providers, including your dentist, that you have a pacemaker. Stay away from strong magnets. Make regular follow – up appointments with your doctor. He /She will check the pacemaker to make sure it’s working properly. Carry pacemaker information card at all the times. Don’t drive until your doctor says it’s ok. If any complications arises, report the physician immediately.

29. PATIENT AND FAMILY TEACHING Maintain follow up care with a physician to check the pacemaker site and begin regular pacemaker function checks. Watch for signs of infection at incision site redness, swelling dressing. Keep incision dry for 1 week after implantation. Avoid lifting operative site arm above shoulder level until approved by care provider. The patient should be taught how to take the pulse. Carry pacemaker information card at all the times.

30. SUMMARY A pacemaker is a small device implanted in the chest. It sends electrical signals to start or regulate a slow heart beat. It’s most often placed in the chest just under the collarbone. Pacemakers are used to treat arrhythmias, or abnormal heart rhythms, and they help in monitoring the heart rhythm. Pacemaker can sense when the heart’s natural rate falls below the rate that has been programmed into the pacemaker.

31. EVALUATION Introduce pacemaker. Define pacemaker. What are the components of pacemaker ? How pacemaker works ? What are the types of pacemaker ? Enlist the indications of permanent pacemaker and temporary pacemaker. What are the methods of pacing ? What are pacing modes ? What are the causes for a pacemaker failure ? What are the signs of pacemaker failure ? What are the complications of pacemaker ? What are the nursing diagnosis ? Discuss the nursing management of pacemaker. How the patient will take care of implanted pacemaker ? What should be the patient and family teaching given on pacemaker ?

32. NEW RESEARCH DONE ON IT Glenfield Hospital has become the first hospital in the UK and Ireland to implant the world’s smallest, wireless pacemaker – the size of a large vitamin – into a patient’s heart. According to a new study by scientists at the UC San Francisco Weill Institute for Neurosciences is that Irregular circadian rhythm in older adults associated with increased risk of Parkinson’s disease. Pacemakers and other cardiac devices can help solve forensic cases, according to a study presented at EHRA EUROPACE- CARDIOSTIM 2017. Devices revealed the time and cause of death in some cases where autopsy failed to do so.

33. REFERENCE BOOKS INTERNET DISCUSSION WITH TEACHER

34. BIBLIOGRAPHY Ansari Javed , textbook of medical surgical nursing, volume – 2, PV publications, page no- 1788 to 1798. Brunner and Suddarth’s ‘ Textbook of Medical Surgical Nursing’, South Asia edition, volume – 2, Wolters kluwer publications, page no – 1231 to 1245. www.wikipedia.com www.slideshare.com www.ncbi.nlm.nih.gov