A pacemaker is an electronic device that provides electrical stimuli to the heart muscle. Pacemakers provide an electrical stimulus to depolarize the heart and cause a contraction to occur at a controlled rate. The function of the pacemaker (or pacer) is to maintain the heart rate when the patient’s own intrinsic system is unable to do so. The stimulus of the pacer is produced by a pulse generator and delivered via electrodes or leads that are implanted in the epicardium or endocardium. The electrodes may be unipolar or bipolar, and the proximal end attaches to a pulse generator that is placed in the chest or abdomen.
Nursing Care Plans
Nursing care for patients with pacemakers involves the monitoring and prevention of common complications, preventing dislodgement, and educating the patient on the proper use and maintenance of the pacemaker.
Here are six (6) pacemaker therapy nursing care plans:
- Ineffective Tissue Perfusion
- Impaired Skin Integrity
- Risk for Injury
- Risk for Infection
- Impaired Physical Mobility
- Disturbed Body Image
Ineffective Tissue Perfusion: Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.
- Ineffective Tissue Perfusion: Cardiopulmonary, Cerebral
May be related to
- Cardiac dysrhythmias
- Heart blocks
- Decreased blood pressure
- Decreased cardiac output
- Pacemaker battery failure
Possibly evidenced by
- Decreased blood pressure
- Decreased heart rate
- Decreased cardiac output, stroke volume
- Increased peripheral vascular resistance
- Changes in level of consciousness
- Mental changes
- Cold clammy skin
- Cardiopulmonary arrest
- Inappropriate pacing or sensing
- Patient will be free of dysrhythmias with an adequate cardiac output to perfuse all body organs.
- Patient will be free of dysrhythmias and be able to maintain cardiac output within normal limits.
- Patient will be able to recall accurately all instructions given.
- Patient will be able to adhere to all activity restrictions.
- Permanent pacemaker function will be without complications, with no lead dislodgement or competitive rhythms noted.
|Monitor ECG for changes in rhythm, rate, and presence of dysrhythmias. Treat as indicated.||Observation for pacemaker malfunction promotes prompt treatment. Pacer electrodes may irritate ventricle and promote ventricular ectopy.|
|Obtain and observe rhythm strip every 4 hours and prn. Notify physician of abnormalities.||Identifies proper functioning of pacemakers, with appropriate capture and sensing.|
|Monitor vital signs every 15 minutes until stable, repeat every 2 hours or prn.||Assures adequate perfusion and cardiac output.|
|Monitor for signs of failure to sense patient’s own rhythm, and correct problem.||Potential causes are lead dislodgement, battery failure, low, sensitivity, wire fracture, or improper placement of the catheter.|
|Ensure that all electrical equipment are grounded. Avoid touching equipment and patient at the same time.||Prevents potential for microshock and accidental electrocution. Electric current seeks the path of least resistance, and the potential for stray current to travel through the electrode into the patient’s heart may precipitate ventricular fibrillation.|
|Monitor for muscle twitching or hiccups.||May indicate pacer lead had dislodged and migrated to chest wall or diaphragm after perforation of the heart.|
|Monitor for sudden complains of chest pain, and auscultate for pericardial friction rub or muffled heart tones. Observe for JVD and pulsus paradoxus.||May indicate perforation of the pericardial sac, and impending or present cardiac tamponade.|
|Monitor patient for complains of dizziness, weakness, fatigue, syncope, edema, chest pain, palpitations, pulsations in neck veins, or dyspnea.||During ventricular pacing, AV synchrony may cease and cause a sudden decrease in cardiac output. This may indicate “pacemaker syndrome” or failure of the pacer to function which results in decreased perfusion.|
|Limit movement of extremity involved near insertion site as ordered.||Prevents accidental disconnection and dislodgement of lead wires immediately after placement.|
|Monitor patient for low blood-sugar levels, use glucocorticoids or sympathomimetics, mineralocorticoids, or anesthetics.||May impair the pacemaker stimulation threshold.|
|Protect patient from microwave ovens, radar, diathermies, and etc.||Environmental electromagnetic interference may impair demand pacemaker function by disrupting the electrical stimulus.|
|If patient arrests, and requires defibrillation, attempt to avoid pacemaker battery location as site for defibrillation. If patient is successfully resuscitated, prepare for potential reprogramming of pacemaker.||Defibrillatory shock may result in pacemaker damage and potential diversion of electrical current. Pacemakers may be damaged or settings may be altered by application of electrical current required to resuscitate patient.|
|Instruction patient on need for pacemaker, procedures involved, expected outcomes, and etc.||Provides knowledge, decreases fear and anxiety, and provides baseline for further instruction.|
|Instruction patient in checking pulse rate every day for 1 month, then every week, and to notify physician if rate varies more than 5 beats/minute.||Provides patient with some control over situation. Assists in promoting a sense of security; allows prompt recognition of deviations from preset rate and potential pacemaker failure.|
|Instruct on limitations on activity: avoid excessive bending, stretching, lifting heavy, strenuous exercise, or contact sports.||Full range of motion can be recovered in approximately 2 months after fibrosis stabilizes pacemaker lead. Excessive activity may cause lead dislodgement.|
|Instruct to avoid shoulder-strap purses, suspenders, or firing rifle resting over generator site.||May promote irritation over implanted generator site.|
|Instruct to wear a medicalert bracelet with information about type of pacemaker and rate.||Provides, necessary information about the patient, condition, and pacemaker should patient be incapacitated and unable to speak for self.|
|Instruct patient to notify physician if radiation therapy is needed, and to wear lead shield if it’s required.||Radiation therapy can cause failure of the silicone chip in the pacer with repeated radiation treatment.|
|Instruct patient/family regarding avoiding electromagnetic fields, magnetic resonance imaging, radio transmitters, and the like. If patient notices dizziness or palpitations, patient should try to move away from the area, and if symptoms persists, seek medical attention.||May affect the function of the pacemaker and alter the programmed settings.|
You may also like the following posts and care plans:
- 1,000+ Nursing Care Plans List – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- What is a Nursing Care Plan? 9 Steps on How to Write a Care Plan – learn how to write an excellent care plan. We explain the concepts and walk you through the steps.
- Nursing Diagnosis: The Complete List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
- The Ultimate Guide to Nursing Diagnosis – learn how to formulate nursing diagnoses correctly in this easy-to-follow guide!
Cardiac Care Plans
Nursing care plans about the different diseases of the cardiovascular system:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 16+ Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 7 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans