6 Cardiac Arrhythmias Nursing Care Plans and Management

This nursing care plan and management guide can assist in providing care for patients with cardiac dysrhythmias and digital toxicity. Get to know the nursing assessment, interventions, goals, and nursing diagnosis to promote safe nursing care for patients with cardiac arrythmias.

What are cardiac dysrhythmias?

Cardiac arrhythmias, also known as cardiac dysrhythmias, are abnormal electrical conduction or automatic changes in heart rate and rhythm. Arrhythmias vary in severity, from those that are mild, asymptomatic, and require no treatment to catastrophic ventricular fibrillation, which necessitates immediate resuscitation. It can be the result of a primary cardiac disorder, a response to a systemic condition, the result of electrolyte imbalance, or drug toxicity.

Dysrhythmias vary in severity and in their effects on cardiac function, which are partially influenced by the site of origin (ventricular or supraventricular).

Nursing Care Plans and Management

Nursing care planning for patients with cardiac arrhythmia due to digitalis toxicity includes prompt assessment of the patient’s condition, prompt treatment of symptoms, and investigation of the cause.

Nursing Problem Priorities

The following are the nursing priorities for patients with cardiac arrhythmias:

1. Treat life-threatening dysrhythmias.
2. Assess and identify cause or precipitating factors.
3. Providing patient education and health teachings.

Nursing Assessment

Assess for the following subjective and objective data:

• Heart rate. Assessing the heart rate is essential to identify the presence and type of dysrhythmia. Variations from the normal range can indicate tachycardia (fast heart rate) or bradycardia (slow heart rate), which are common dysrhythmias.
• Rhythm. Determining the regularity or irregularity of the heart rhythm is crucial in identifying dysrhythmias.
• Blood pressure. Measuring and monitoring blood pressure provides information about the patient’s hemodynamic stability and helps detect any abnormalities associated with dysrhythmias, such as hypertension or hypotension. Dysrhythmias can impair cardiac output and lead to variations in blood pressure, indicating compromised cardiovascular function.

Assess for factors related to the cause of cardiac arrhythmias:

• Altered electrical conduction
• Reduced myocardial contractility

Nursing Diagnosis

• Decreased cardiac output

Nursing Goals

1. The client will maintain/achieve adequate cardiac output with blood pressure and pulse within the normal range, appropriate urinary output, palpable pulses of equal quality, and a normal level of mentation.
2. The client will experience a reduced frequency or absence of dysrhythmias.
3. The client will actively engage in activities that decrease the workload on the heart.
4. The client will demonstrate understanding of their prescribed medication, including interactions with other drugs or substances, and recognize the importance of adhering to the prescribed regimen.
5. The client will identify signs of digitalis overdose and developing heart failure, and promptly report them to the physician.
6. The client will exhibit no signs of drug toxicity and maintain serum drug levels within an acceptable range specific to the individual.
7. The client, if utilizing a pacemaker, will comprehend their condition, prognosis, and the function of the pacemaker.
8. The client will recognize signs of pacemaker failure.
9. The client will verbalize understanding of their therapeutic regimen.
10. The client will list the desired actions and potential adverse side effects of their medications.
11. The client will correctly perform necessary procedures and provide explanations for their actions.

Nursing Interventions and Actions

Cardiac arrhythmias are disturbances in the normal heart rhythm. Nursing interventions for managing these conditions involve monitoring and managing symptoms, administering medications and treatments, and providing patient education. The aim is to control the arrhythmia, prevent complications, and improve the patient’s quality of life. Effective nursing care also involves working closely with the healthcare team to develop an individualized care plan and ensure proper communication and coordination of care.

• 1. Managing Impaired Cardiac Function
• 2. Monitoring Diagnostic Procedures and Laboratory Studies
• 3. Administering Medications and Providing Pharmacological Interventions
• 4. Preventing Digitalis Toxicity & Poisoning
• 5. Reducing Anxiety
• 6. Providing Perioperative Nursing Care
• 7. Providing Patient Education and Health Teachings

1. Managing Impaired Cardiac Function

Irregular heart rhythm can impair the heart’s ability to effectively pump blood, resulting in decreased oxygen and nutrient delivery to essential organs and decreased blood flow to the body. Effective management and treatment of cardiac dysrhythmias are essential for lowering the risk of decreased cardiac output and sustaining good cardiovascular health.

1. Palpate pulses (radial, carotid, femoral, dorsalis pedis), noting rate, regularity, amplitude (full or thready), and symmetry. Document the presence of pulsus alternans, bigeminal pulse, or pulse deficit.
Differences in pulse equality, rate, and regularity are indicative of the effect on the systemic or peripheral circulation of altered cardiac output.

2. Auscultate heart sounds, noting rate, rhythm, presence of extra heartbeats, and dropped beats.
Specific dysrhythmias are more clearly detected audibly than by palpation. Hearing extra heartbeats or dropped beats helps identify dysrhythmias in the unmonitored patient.

3. Monitor vital signs. Assess the adequacy of cardiac output and tissue perfusion, noting significant variations in BP/pulse rate equality, respirations, changes in skin color, temperature, level of consciousness, sensorium, and urine output during episodes of dysrhythmias.
Although not all dysrhythmias are life-threatening, immediate treatment may be required to terminate dysrhythmia in the presence of alterations in cardiac output and tissue perfusion.

4. Investigate reports of chest pain, documenting the location, duration, intensity (0–10 scale), and relieving or aggravating factors. Note nonverbal pain cues: facial grimacing, crying, changes in BP/heart rate.
Reasons for chest pain are variable and depend on the underlying cause. However, chest pain may indicate ischemia due to altered electrical conduction, decreased myocardial perfusion, or increased oxygen need.

5. Be prepared to initiate cardiopulmonary resuscitation (CPR) as indicated.
The development of life-threatening dysrhythmias requires prompt intervention to prevent ischemic damage/death.

6. Insert and maintain IV access.
Patent access line may be required for the administration of emergency drugs.

7. Administer medications for cardiac arrhythmias as indicated:
See Pharmacologic Management

2. Monitoring Diagnostic Procedures and Laboratory Studies

Monitoring diagnostic procedures and laboratory studies for patients with cardiac arrhythmias is crucial to ensure that the nursing care plan is effective and appropriate for the patient’s condition. By tracking the results of these procedures, healthcare providers can adjust medications and treatments, evaluate the patient’s response to therapy, and prevent potential complications or adverse reactions. This also enables them to make informed decisions and provide the best possible care for the patient.

1. Determine the type of dysrhythmia and document it with a rhythm strip (if cardiac/telemetry monitoring is available):

• 1.1. Sinus tachycardia
  Useful in determining the need for/type of intervention required. Tachycardia can occur in response to stress, pain, fever, infection, coronary artery blockage, valvular dysfunction, hypo­volemia, hypoxia, or as a result of decreased vagal tone or of increased sympathetic nervous system activity associated with the release of catecholamines. Although it generally does not require treatment, persistent tachycardia may worsen underlying pathology in patients with ischemic heart disease because of shortened diastolic filling time and increased oxygen demands. These patients may require medications.

• 1.2. Sinus bradycardia
  Bradycardia is common in patients with acute MI (especially anterior and inferior) and is the result of excessive parasympathetic activity, blocks in conduction to the SA or AV nodes, or loss of automaticity of the heart muscle. Patients with severe heart disease may not be able to compensate for a slow rate by increasing stroke volume. Therefore, decreased cardiac output, HF, and potentially lethal ventricular dysrhythmias may occur.

• 1.3. Atrial dysrhythmias:
  • Premature Atrial Contractions (PACs)
    PACs can occur as a response to ischemia and are normally harmless but can precede or precipitate atrial fibrillation.
  • Atrial flutter
    Acute and chronic atrial flutter and/or fibrillation (the most common dysrhythmia) can occur with coronary artery or valvular disease and may or may not be pathological.
  • Atrial supraventricular tachycardias (PAT, MAT, SVT)
    Rapid atrial flutter/fibrillation reduces cardiac output as a result of incomplete ventricular filling (shortened cardiac cycle) and increased oxygen demand.

• 1.4. Ventricular Dysrhythmias
  • Premature ventricular contractions or ventricular premature beats (PVCs/VPBs), ventricular tachycardia (VT), ventricular flutter or fibrillation (VF)
    PVCs or VPBs reflect cardiac irritability and are commonly associated with MI, digitalis toxicity, coronary vasospasm, and misplaced temporary pacemaker leads. Frequent, multiple, or multifocal PVCs result in diminished cardiac output and may lead to potentially lethal dysrhythmias, e.g., VT or sudden death/cardiac arrest from ventricular flutter/fibrillation. Intractable ventricular dysrhythmias unresponsive to medication may reflect ventricular aneurysm. Polymorphic VT (torsades de pointes) is recognized by the inconsistent shape of QRS complexes and is often drug-related, e.g., procainamide (Pronestyl), quinidine (Quinaglute), disopyramide (Norpace), and sotalol (Betapace). Reflect altered transmission of impulses through normal conduction channels (slowed, altered) and may be the result of MI, coronary artery disease with reduced blood supply to sinoatrial (SA) or atrioventricular (AV) nodes, drug toxicity, and sometimes cardiac surgery.
  • Heart blocks
    Progressing heart block is associated with slowed ventricular rates, decreased cardiac output, and potentially lethal ventricular arrhythmias or cardiac standstill.

2. Monitor laboratory studies:

• 2.1. Electrolytes
  An imbalance of electrolytes, such as potassium, magnesium, and calcium, adversely affects cardiac rhythm and contractility. Electrolyte imbalances can cause changes in the electrical conduction system of the heart, leading to abnormal heart rhythms.

• 2.2. Drug levels
  Reveal therapeutic or toxic levels of prescription medications or street drugs that may affect or contribute to the presence of dysrhythmias.

3. Prepare and assist with elective cardioversion.
May be used in atrial fibrillation or certain unstable dysrhythmias to restore normal heart rate and relieve symptoms of heart failure.

3. Administering Medications and Providing Pharmacological Interventions

Administering medications and providing pharmacological interventions is important for patients with cardiac arrhythmias to control heart rhythm, prevent blood clots, and reduce the risk of stroke and other complications. Proper medication management can help improve the patient’s quality of life, reduce hospitalizations, and lower the risk of mortality associated with arrhythmias. Close monitoring of the patient’s response to medications is also necessary to ensure that the treatment plan is effective and appropriate for their condition.

1. Administer supplemental oxygen as indicated.
Increases the amount of oxygen available for myocardial uptake, which decreases irritability caused by hypoxia.

2. Potassium
Dysrhythmias are generally treated symptomatically. Correction of hypokalemia may be sufficient to terminate some ventricular dysrhythmias. Potassium imbalance is the number one cause of atrial fibrillation.

3. Antidysrhythmics
Antidysrhythmics are medications used to regulate heart rhythm and treat various types of arrhythmias. These include:

• 3.1. Class I drugs
  Class I drugs depress depolarization and alter repolarization, stabilizing the cell. These drugs are divided into groups a, b, and c, based on their unique effects. These drugs increase action potential, duration, and effective refractory period and decrease membrane responsiveness, prolonging both QRS complex and QT interval. Useful for the treatment of atrial and ventricular premature beats, and repetitive arrhythmias (atrial tachycardias and atrial flutter or fibrillation). Myocardial depressant effects may be potentiated when class Ia drugs are used in conjunction with medications possessing similar properties.
  • Class Ia drugs: disopyramide (Norpace), procainamide (Pronestyl, Procan SR), quinidine (Quinaglute, Cardioquin)
    These drugs shorten the duration of the refractory period (QT interval), and their action depends on the tissue affected and the level of extracellular potassium.
  • Class Ib: lidocaine (Xylocaine), phenytoin (Dilantin), tocainide (Tonocard), mexiletine (Mexitil); moricizine (Ethmozine)
    Drugs of choice for ventricular dysrhythmias are also effective for automatic and reentrant arrhythmias and digitalis-induced dysrhythmias. These drugs may aggravate myocardial depression.
  • Class Ic: flecainide (Tambocor), propafenone (Rythmol), encainide (Enkaid)
    These drugs slow conduction by depressing SA node automaticity and decreasing conduction velocity through the atria, ventricles, and Purkinje fibers. The result is a prolongation of the PR interval and a lengthening of the QRS complex. They suppress and prevent all types of ventricular dysrhythmias. Flecainide increases the risk of drug-induced dysrhythmias post-MI. Propafenone can worsen or cause new dysrhythmias, a tendency called the “proarrhythmic effect.” Encainide is available only for patients who demonstrated good results before the drug was removed from the market.

• 3.2. Class II drugs: atenolol (Tenormin), propranolol (Inderal), nadolol (Corgard), acebutolol (Sectral), esmolol (Brevibloc), sotalol (Betapace); bisoprolol (Zebeta)
  Beta-adrenergic blockers have antiadrenergic properties and decrease automaticity. Therefore, they are useful in the treatment of dysrhythmias caused by SA and AV node dysfunction (SVTs, atrial flutter, or fibrillation). These drugs may exacerbate bradycardia and cause myocardial depression, especially when combined with drugs that have similar properties.

• 3.3. Class III drugs: bretylium tosylate (Bretylol), amiodarone (Cordarone), sotalol (Betapace), ibutilide (Corvert)
  These drugs prolong the refractory period and action potential duration, consequently prolonging the QT interval. They are used to terminate ventricular fibrillation and other life-threatening ventricular dysrhythmias or sustained ventricular tachyarrhythmias, especially when lidocaine and procainamide are not effective. Sotalol is a nonselective beta-blocker with characteristics of both class II and class III.

• 3.4. Class IV drugs: verapamil (Calan), nifedipine (Procardia), diltiazem (Cardizem)
  Calcium antagonists (also called calcium channel blockers) slow conduction time through the AV node (prolonging PR interval) to decrease ventricular response in SVTs, and atrial flutter/fibrillation. Calan and Cardizem may be used for bedside conversion of acute atrial fibrillation.

• 3.5. Class V drugs:  atropine sulfate, isoproterenol (Isuprel)
  Miscellaneous drugs are useful in treating bradycardia by increasing SA and AV conduction and enhancing automaticity.

4. Cardiac glycosides: digoxin (Lanoxin)
Cardiac glycosides may be used alone or in combination with other antiarrhythmic drugs to reduce ventricular rate in the presence of uncontrolled or poorly tolerated atrial tachycardias or flutter and fibrillation. First-line treatment for paroxysmal supraventricular tachycardia (PVST).

5. Adenosine (Adenocard)
Slows conduction and interrupts reentry pathways in the AV node. Note: Contraindicated in patients with second or third-degree heart block or those with sick sinus syndrome who do not have a functioning pacemaker.

4. Preventing Digitalis Toxicity & Poisoning

Preventing digitalis toxicity and poisoning is essential in patients with cardiac arrhythmias who are taking digoxin to control their heart rate. Digitalis toxicity can cause serious side effects such as nausea, vomiting, and arrhythmias, which can worsen the patient’s condition. Regular monitoring of the patient’s digoxin levels and symptoms of toxicity is necessary to prevent adverse reactions and ensure safe and effective treatment.

1. Discuss the necessity of periodic laboratory evaluation:

• 1.1. Serum digoxin (Lanoxin) or digitoxin (Crystodigin) level
  Digitalis has a narrow therapeutic serum range, with toxicity occurring at levels that are dependent on individual response. Laboratory levels are evaluated in conjunction with clinical manifestations and ECG to determine individual therapeutic levels or resolution of toxicity.

• 1.2. Electrolytes, BUN, creatinine, liver function studies
  Abnormal levels of potassium, calcium, or magnesium increase the heart’s sensitivity to digitalis. Impaired kidney function can cause digoxin (mainly excreted by the kidney) to accumulate to toxic levels. Digitoxin levels (mainly excreted by the bowel) are affected by impaired liver function.

2. Explain the patient’s specific type of digitalis preparation and its specific therapeutic use.
Reduces confusion due to digitalis preparations varying in the name (although they may be similar), dosage strength, and onset and duration of action. Up to 15% of all patients receiving digitalis develop toxicity at some time during the course of therapy because of its narrow therapeutic range.

3. Instruct patient not to change the dose for any reason, not to omit dose (unless instructed to, depending on pulse rate), not to increase the dose or take extra doses, and to notify the health care provider if more than one dose is omitted.
Alterations in drug regimens can reduce therapeutic effects, result in toxicity, and cause complications.

4. Advise the patient that digitalis may interact with many other drugs (barbiturates, neomycin, cholestyramine, quinidine, and antacids) and that the physician should be informed that digitalis is taken whenever new medications are prescribed. Advise the patient not to use OTC drugs (laxatives, antidiarrheals, antacids, cold remedies, diuretics, and herbals) without first checking with the pharmacist or healthcare provider.
Knowledge may help prevent dangerous drug interactions.

5. Review the importance of dietary and supplemental intake of potassium, calcium, and magnesium.
Maintaining electrolytes at normal ranges may prevent or limit the development of toxicity and correct many associated dysrhythmias.

6. Provide information and have the patient or SO verbalize understanding of toxic signs and symptoms to report to the healthcare provider.
Nausea, vomiting, diarrhea, unusual drowsiness, confusion, very slow or very fast irregular pulse, thumping in chest, double or blurred vision, yellow or green tint or halos around objects, flickering color forms or dots, altered color perception, and worsening heart failure (dependent or
generalized edema, dyspnea, decreased amount and/or frequency of voiding) indicate need for prompt evaluation or intervention. Mild symptoms of toxicity may be managed with a brief drug holiday. In severe or refractory heart failure, altered cardiac binding of digitalis may result in toxicity, even with previously appropriate drug doses.

7. Administer medications as appropriate: Other antiarrhythmic medications, lidocaine (Xylocaine), propranolol (Inderal), and procainamide (Pronestyl) Digoxin immune Fab (Digibind).
May be necessary to maintain and improve cardiac output in presence of the excess effects of digitalis. A digoxin or digitoxin antagonist increases drug excretion by the kidneys in acute or severe toxicity when standard therapies are unsuccessful.

8. Prepare patient for transfer to CCU as indicated (dangerous dysrhythmias, exacerbation of heart failure).
In the presence of digitalis toxicity, patients frequently require intensive monitoring until therapeutic levels have been restored. Because all digitalis preparations have long serum half-lives, stabilization can take several days.

5. Reducing Anxiety

Reducing anxiety is crucial for patients with cardiac arrhythmias because anxiety can worsen arrhythmias and lead to other complications. Stress-reduction techniques, such as deep breathing, relaxation exercises, and counseling, can help alleviate anxiety and improve the patient’s overall well-being. By reducing anxiety, healthcare providers can help the patient better cope with their condition and improve their overall treatment outcomes.

1. Provide a quiet and calm environment. Review reasons for the limitation of activities during the acute phase.
Reduces stimulation and release of stress-related catecholamines, which can cause or aggravate dysrhythmias and vasoconstriction, increasing myocardial workload.

2. Demonstrate and encourage the use of stress management behaviors: relaxation techniques, guided imagery, and slow/deep breathing.
Promotes patient participation in exerting some sense of control in a stressful situation.

6. Providing Perioperative Nursing Care

Providing perioperative nursing care is necessary for patients with cardiac arrhythmias because they are at increased risk of developing arrhythmia exacerbation and other complications during surgery. Close monitoring and appropriate interventions, such as administering medications and optimizing fluid management, can help prevent adverse events and improve the patient’s surgical outcomes. Proper perioperative care is crucial to ensure the safety and well-being of patients with cardiac arrhythmias undergoing surgery.

1. Assist with insertion and maintenance of pacemaker function.
Temporary pacing may be necessary to accelerate impulse formation or override tachydysrhythmias and ectopic activity, to maintain cardiovascular function until spontaneous pacing is restored or permanent pacing is initiated.

2. Prepare for invasive diagnostic procedures and surgery as indicated.
A differential diagnosis of the underlying cause may be required to formulate an appropriate treatment plan. Resection of ventricular aneurysm may be required to correct intractable ventricular dysrhythmias unresponsive to medical therapy. Surgery: CABG, may be indicated to enhance circulation to the myocardium and conduction system.

3. Prepare for implantation of a cardioverter or defibrillator (ICD) when indicated.
This device may be surgically implanted in those patients with recurrent, life-threatening ventricular dysrhythmias unresponsive to tailored drug therapy. The latest generation of devices can provide multilevel (“tiered”) therapy, that is, anti-tachycardia and anti-bradycardia pacing, cardioversion, or defibrillation, depending on how each device is programmed.

7. Providing Patient Education and Health Teachings

Providing patient education and health teachings is necessary for patients with cardiac arrhythmias and their families to understand the nature of the condition, its management, and potential complications. Education on self-care strategies, medication management, lifestyle modifications, and recognizing signs and symptoms of arrhythmia exacerbation can empower patients to take an active role in their care and improve their overall quality of life. Health teachings also help family members understand how to support the patient and provide appropriate assistance when needed.

1. Assess the patient and significant other‘s (SO) level of knowledge and ability and desire to learn.
Necessary for the creation of individual instruction plans. Engaging and empowering patients in their own care can improve outcomes, increase their involvement in decision-making, and enhance their overall experience and satisfaction. Reinforces expectation that this will be a “learning experience.” Verbalization identifies misunderstandings and allows for clarification.

2. Be alert to signs of avoidance: changing the subject away from information being presented or extremes of behavior (withdrawal or euphoria).
Natural defense mechanisms, such as anger or denial of the significance of the situation, can block learning, affecting the patient’s response and ability to assimilate information. Changing to a less formal or structured style may be more effective until the patient and SO is ready to accept or deal with the current situation.

3. Present information in varied learning formats: programmed books, audiovisual tapes, question-and-answer sessions, and group activities.
Multiple learning methods may enhance the retention of material.

4. Provide information in written form for the patient/SO to take home.
Follow-up reminders may enhance the patient’s understanding and cooperation with the desired regimen. Written instructions are a helpful resource when the patient is not in direct contact with the healthcare team.

5. Reinforce explanations of risk factors, dietary and activity restrictions, medications, and symptoms requiring immediate medical attention.
Provides the opportunity for patients to retain information and assume control and participate in a rehabilitation program.

6. Encourage identification and reduction of individual risk factors: smoking and alcohol consumption, and obesity.
These behaviors and chemicals have a direct adverse effect on cardiovascular function and may impede recovery and increase the risk of complications. Smoking has detrimental effects on the cardiovascular system, including increasing the risk of developing cardiac arrhythmias by damaging the heart and blood vessels, increasing heart rate and blood pressure, and reducing oxygen supply to the heart.

7. Review normal cardiac function and electrical conduction.
Provides a knowledge base to understand individual variations and to understand reasons for therapeutic interventions. This also helps the patient better understand their condition and promotes participation in their care by helping them recognize any changes or concerns in their heart rhythm and facilitating prompt reporting to their healthcare provider.

8. Explain and reinforce specific dysrhythmia problems and therapeutic measures to the patient and SO.
Ongoing or updated information (whether the problem is resolved or may require long-term control measures) can decrease anxiety associated with the unknown and prepare the patient/SO to make necessary lifestyle adaptations. Educating the SO may be especially important if the patient is elderly, visually or hearing impaired, or unable or even unwilling to learn and follow instructions. Repeated explanations may be needed because anxiety and/or the bulk of new information can block or limit learning.

9. Identify adverse effects and complications of specific dysrhythmias: fatigue, dependent edema, progressive changes in mentation, and vertigo.
Dysrhythmias may decrease cardiac output, manifested by symptoms of developing cardiac failure and/or altered cerebral perfusion. Tachydysrhythmias may also be accompanied by debilitating anxiety and feelings of impending doom.

10. Instruct and document teaching regarding medications. Include why the drug is needed (desired action), how and when to take the drug, what to do if a dose is forgotten (dosage and usage information), and expected side effects or possible adverse reactions and interactions with other prescribed or OTC drugs or substances (alcohol, tobacco, herbal remedies), as well as what and when to report to the physician.
Information is necessary for patients to make informed choices and manage their medication regimen. Note: Use of herbal remedies in conjunction with a drug regimen may result in adverse effects (cardiac stimulation, impaired clotting), necessitating evaluation of the product for safe use.

11. Encourage the development of a regular exercise routine, avoiding overexertion. Identify signs and symptoms requiring immediate cessation of activities: dizziness, lightheadedness, dyspnea, and chest pain.
When dysrhythmias are properly managed, normal activity should not be affected. An exercise program is useful in improving overall cardiovascular well-being.

12. Review individual dietary needs and restrictions: potassium, and caffeine.
Depending on the specific problems, the patient may need to increase dietary potassium, such as when potassium-depleting diuretics are used. Caffeine may be limited to prevent cardiac excitation. High potassium levels can increase the risk of arrhythmias, while excessive caffeine intake can cause increased heart rate and palpitations. Understanding a patient’s dietary restrictions and needs allows the nurse to provide education and resources to help the patient maintain a heart-healthy diet and manage their condition effectively, reducing the risk of complications and improving quality of life.

13. Demonstrate proper pulse-taking technique. Recommend weekly checking of pulse for 1 full minute or daily recording of the pulse before medication and during exercise as appropriate. Identify situations requiring immediate medical intervention: dizziness or irregular heartbeat, fainting, chest pain.
Continued self-observation and monitoring provide for timely intervention to avoid complications. The medication regimen may be altered, or further evaluation may be required when the heart rate varies from the desired rate or the pacemaker’s preset rate.

14. Review safety precautions, techniques to evaluate and maintain pacemaker or ICD function, and symptoms requiring medical intervention: report pulse rate below set the limit for demand pacing or less than the low-limit rate for rate-adaptive pacers, and prolonged hiccups.
Promotes self-care and provides for timely interventions to prevent serious complications. Instructions and concerns depend on the function and type of device, as well as the patient’s condition and the presence or absence of family or caregivers.

15. Recommend wearing a medical alert bracelet or necklace and carrying a pacemaker ID card.
Allows for appropriate evaluation and timely intervention, especially if the patient is unable to respond in an emergency situation.

16. Discuss environmental safety concerns, e.g., microwave ovens and other electrical appliances (including electrical blankets, razors, radio/TV), which can be safely operated if they are properly grounded and in good repair. There is no problem with metal detectors, although pacemakers may trigger sensitive detectors. In addition, cordless phones are safe, cellular phones held directly over pacemakers may cause interference, so it is recommended that patients not carry phones in a shirt pocket when the phone is on. Additionally, high-voltage areas, magnetic fields, and radiation can interfere with optimal pacemaker function. Patients should avoid high-tension electric wires, arc welding, and large industrial magnets, e.g., demolition sites and MRI.
Aids in clarifying misconceptions and fears, and encourages patients to be proactive in avoiding potentially harmful situations.

Recommended Resources

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See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
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Other nursing care plans for cardiovascular system disorders:

• Angina Pectoris (Coronary Artery Disease)
• Cardiac Arrhythmia (Digitalis Toxicity)
• Cardiac Catheterization
• Cardiogenic Shock
• Congenital Heart Disease
• Decreased Cardiac Output & Cardiac Support
• Heart Failure
• Hypertension
• Hypovolemic Shock
• Impaired Tissue Perfusion & Ischemia
• Myocardial Infarction
• Pacemaker Therapy