Care of pt on hemodynamics
Pacemaker
indications for...
Purpose:
control a fast heart rhythm
coordinate the chambers of the heart
speed up a slow heart rhythm
Permanent Pacemaker
Temporary Pacemaker
acute symptomatic bradycardia
Permanent Pacemakersystem revisions
Open-heart surgery
Symptomatic bradycardia, Tachyarrhythmias
Postmyocardial infarction, Sinoatrial block, • Sinus arrest
Sick sinus syndrome, Stokes-Adams syndrome, Neurocardiogenic syncope,
Bridge to permanent Pacemaker
Arrhythmias caused by antiarrhythmic drugs
• Advanced symptomatic atrioventricular block
Care
Teaching
Teach S&S of Pacemaker failure
swollen ankles or feet, anxiety, forgetfulness, or confusion
palpitations, a fast heart rate, a slow heart rate,
dizziness, fainting, dyspnea
Pacemaker battery
5-15 years ( average of 6-7yrs)
Pt will need identification card with details of Pacemaker
avoid: for the first 4 weeks
patient how to monitor the heart rate and rhythm, including parameters for rate and the need to notify the practitioner
excessive pressure over the insertion site,
extending his arms over his head
making sudden moves,
• Tell the patient about any diet or activity restrictions ordered
Swan-Ganz Catheter
Purpose:
Indications:
catheter from R. side of the heart to arteries in lungs
monitor the heart's function and blood flow
Leaky heart valves (valvular regurgitation),
Abnormal pressures in the heart
HF, Kidney dysfunction, shock
Congenital heart disease
Burns
monitor for complications of heart attack
Evaluate heart medicines effectiveness
Can diagnose:
Pulmonary hypertension
Restrictive cardiomyopathy
Cardiac tamponade
Procedure
positioned supine and flat
Complications:
Nurse Role:
bruising around insertion site; Embolism
Injury to the vein; Cardiac arrhythmias;
Puncture = pneumothorax
Infection, Low blood pressure,
Infection, Cardiac tamponade,
Continuously observe the characteristic waveforms on the monitor as the catheter is moved through the heart to the PA.
Monitor ECG continuously for dysrhythmias (sepecially: right ventricle)
apply an occlusive dressing
Arterial Pressure-Based Cardiac Output
Indications:
Stroke volume variance (SVV)
Minimally invasive means of monitoring continuous cardiac output/continuous cardiac index by taking readings every 20 seconds
controlled mechanical ventilation,
fixed RR, fixed tidal volume at 8 mL/kg
determining whether pt will benefit from either additional fluid volume or inotropic support
SV norm range 60-150 mL/beat
indicator to preload responsiveness
CO norm range 4-8 L/min
SVV norm <13%
↓SV↓CO and normal SVV = inotropic support
↓SV↓CO, +SVV = fluid volume support
• SVV limitations (not APCO use for CO monitoring) in pt with arrhythmias and at risk for fluid overload
Takes pt arterial wave form, gender, age, ht and wt to calculate SV; calculates CCO/ CCI and SV/SVV with the SV and PR
Automated Implantable Cardioverter-Defibrillator (AICD)
Teach the client
Function:
monitors HR and rhythm like a built-in EKG
the heart when in tach. and speed the heart when brady
Smart device:
This prevents unnecessary shocks
Algorithmsare used to detect and determine what type of problem is occurring
Avoid/Do not...
Lifestyle change
Report to the DR if....
If your ICD fires more than once, contact EMS
If your ICD fires and you feel sick, contact the EMS
lift on implant side
MRI’s, large magnets, or strong EM fields
stand near antitheft devices in stores
signs of infection at site
Caregivers need CPR training
Inform airport security of device
No sex or driving until approved by cardiologist
Medic alert bracelet should be worn at all times with a list of medications
feeling of defibrillation should be described as a feeling of a blow to the chest
Generator placed subcut over pectoral muscle;
lead goes through subclavian vein to endocardium