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NURSING CARE OF PT UNDER HEMODYNAMIC MONITORING, IABP, PACEMAKER AND…
NURSING CARE OF PT UNDER HEMODYNAMIC MONITORING, IABP, PACEMAKER AND DEFIBRILLATOR
Calibrate and level the system once per shift using right atrium as reference.
To calibrate make sure to Zero it too atmospheric pressure
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Mark the right atrial position (at 4th intercostal space, midaxillary line) and use this as reference point for all readings.
Stopcock nearest Transducer should be at this level
Called Phlebostatic Axis
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To maintain patency of line
Maintain 300 mmHg pressure on the flush solution at all times.
Flush bag contains fluid
System is delivering at 3-6 ml/ hr
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Assess and document appearance of insertion site every shift; observe for signs of infiltration, infection, or phlebitis.
Change IV solutions q24hrs, site dressing q48hrs, tubing to insertion site q72hrs.
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Apply manual pressure 5-15 minutes to the insertion site as soon as the catheter tip is out when discontinuing pressure line.
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Make sure that electrical equipment is grounded, intact, and operating as expected.
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Synchronized Cardioversion:
Is the therapy of choice used for pts with ventricular tachydysrhythmias (VT) or supraventricular tachydysrhythmias(afib).
*This is similar to defibrillation except Synchronizer switch must be on when cardioversion is being done
A synchronized circuit in the defibrillator delivers Shock that are programmed to occur on the R wave of QRS
If synchronized cardioversion is done on nonemergent basis (pt is awake and stable) pt is sedated before procedure
Maintain patent airway
Start the Initial energy for synchronized cardioversion (biphasic:50-100 joules Monophasic: 100 joules
If pt becomes pulseless or rhythm changes to Ventricular Fibrillation turn of sync switch off and perform defibrillation
Implanted Cardioverter Defibrillator
consist of a lead system placed via subclavian vein to the endocardium. A battery powered pulse is implanted subcutaneously. Usually on pectoral muscle on nondominant side.
Sensing system monitors HR& rhythm-delivers 25 joules or less to heart when it detects a lethal dysrhythmia
Care:
• Follow up appointments
• Report s/s of infection(pain ,swelling)
• Keep incision dry for 4 days after insertion or as instructed
• Avoid lifting arm on ICD side above the shoulder until approved
• Sex is usually safe after healed incision, but ask cardiologist
• Avoid driving until cleared by cardiologist.
• Avoid direct blows to ICD
• Avoid large magnets and strong electromagnetic field/no MRIs unless approved
• Air travel is not restricted, just inform security about ICD (set off metal detectors)
• Avoid standing near antitheft devices
• Call cardiologist immediately if ICD fires
• If ICD fires and feel sick call EMS
• Wear Medical alert bracelets/carry ICD card
• Caregivers need to learn CPR
Defibrillation
Is the treatment of choice to end Ventricular fibrillation & pulseless VT.
Use within 2 minutes is critical for success
Most effective when myocardial cells are not anoxic or acidotic
Goal: Repolarization of myocardial cells will allow the SA node to resume the role of pacemakers
Energy is delivered in 2 forms:
-monophasic: delivers energy in one direction & is recommended to start at 360 joules
-biphasic- delivers energy in 2 directions (deliver shock at 120-200 joules
When preparing to defibrillate make sure synchronizer switch is off on nthe AED(it should be on only for synchronized cardioversion)
Pacemakers
Permanent pacemaker
•Implanted totally within the body
•Power source is placed subcutaneously usually over the pectoral muscle on the patient’s nondominant side.
•Leads are placed transvenously to the right atrium and/or one or both ventricles and attached to the power source.
Temporary pacemaker There are three types:
•Transvenous pacemaker
•Epicardial pacing
•Transcutaneous pacemaker (TCP)
Nursing care
•Limit arm and shoulder activity on the operative side to prevent dislodging the newly implanted pacing leads
•Observe the insertion site for signs of bleeding, and check that the incision is intact
•Note any temperature elevation or pain at the insertion site and treat as ordered
•Monitor with ECG and evaluate the status of the pacemaker for malfunctions
•Provide patient and caregiver teaching
Complications of invasive temporary or permanent pacemaker
•Infection and hematoma formation at the insertion site
•Pneumothorax
•Failure to sense or capture
•Perforation of the atrial or ventricular septum by the pacing lead
•Appearance of “end-of-life” battery power on testing the pacemaker
Hemodynamic monitoring includes several methods of measuring the stability of cardiovascular system,fluid volume and oxygenation.
Indications
Acute hypertension/ hypotenison
Respiratory failure
Shock
Frequent ABGs
Coronary interventions
Heart Failute
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