1. The client/caregiver can define a pacemaker.
   1. It provides an artificial electrical stimulus to the heart muscle to control or maintain a regular rhythm heartbeat.
   2. It consists of a battery-powered pulse generator and a catheter electrode that is inserted into the right side of the heart or ventricle.
   3. A pacemaker can be temporary (external) or permanent (internal).
2. The client/caregiver can list and describe two types of pacemakers.
   1. A demand-rate pacemaker generates an electrical stimulus only if the heart rate falls below a preset level.
   2. A fixed-rate pacemaker is set at a certain rate and constantly creates electrical stimuli regardless of the heart’s rhythm.
3. The client/caregiver can list measures for pacemaker management.
   1. Monitor the pulse at rest as instructed by the physician, and report the rate if less than set the amount.
   2. Report fatigue, shortness of breath, palpitations, dizziness, chest pain, and so forth.
   3. Assess wound and report signs and symptoms of infection (i.e., redness, tenderness, drainage, and fever).
   4. Avoid any type of trauma to the pulse generator.
      1. Avoid constrictive clothing.
      2. Avoid bumping the pulse generator.
      3. Avoid contact sports.
   5. Follow postoperative activity as ordered.
      1. Resume driving, sexual relations, exercise, and so forth as ordered by physician.
      2. Most activities can be resumed in 4 to 6 weeks.
      3. Perform range of motion exercises as instructed to the affected shoulder.
4. The client/caregiver can explain special instructions for pacemaker care.
   1. Show pacemaker card at airport security checks.
   2. Inform any health care provider (i.e., dentist, technicians, and physician) of the pacemaker.
   3. Carry a pacemaker identity card that includes
      1. Pacemaker model and leads
      2. Pacemaker settings
      3. Date of insertion, name of surgeon, and hospital with contact telephone numbers
   4. Follow precautions around electricity and strong magnetic fields.
      1. Avoid areas of high voltage such as power plants, radio transmitters, large industrial magnets, and certain anti-theft alarm systems.
      2. Ground home appliances.
      3. Avoid magnetic resonance imaging.
      4. Avoid resting cellular telephone on the chest over the site of the generator.
   5. Wear Medic Alert bracelet.
5. The client/caregiver can state the need for follow-up care.
   1. Keep follow-up appointments with physicians and with pacemaker clinic evaluations.
   2. Keep appointments for battery checks, which may be done at the hospital or at home via telephone system.
   3. Change battery as needed (most last 5 to 10 years).
6. The client/caregiver is aware of signs and symptoms of possible complications.
   1. Infection
   2. Pacemaker malfunction
   3. Bleeding
   4. Cardiac dysrhythmias

Resources

The American Heart Association
800-242-8721
www.aha.org

Manufacturer of the pacemaker

References

Ackley, B. J., & Ladwig, G. B. (2006).Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.
Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing . Philadelphia: Lippincott, Williams & Wilkins.