Student nurse's responsibility for pacemakers

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Hello, so I was wondering what responsibilities a nursing student (3rd year student in 4 year program) would have while caring for a patient who has a pacemaker (not a new one...) while they're on the...i guess it's just a unit for chronic illnesses - are there certain assessments or things we're supposed to be making/monitoring regarding the pacer? I don't remember learning about it very much...just what the functions and possible problems are with them...Thanks!

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transtelephonic monitoring

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Specializes in ER.

Why would you do monitering over the telephone when the patient is right there in the hospital?

I can't think of much. Be aware it changes the EKG strip, and makes it difficult, if not impossible to draw conclusions from the 12 lead EKG. If the patient codes you need to disable the pacer with a large magnet, and then defib. Remember to use the pacing function of the defibrillator once you turn the pacer off.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Hi, jo716, and welcome to allnurses! :welcome:

Well, as someone who has a pacemaker I can tell you that there is nothing special about it. It's just there and I really don't even notice it. So, for assessment purposes the only thing to notice is the patient's pulse rate which should have a low default rate--usually that is set at something like 60. If the patient is being monitored you will be able to tell the pacer induced beats from the patient's own induced heart beats quite easily. If I get around a strong electromagnetic field I get what I can only describe as a hollow feeling in my chest. It's a very strange sensation and very scary.

Outside of that, the only other things you might want to know would be the nursing considerations. Let me quote for you what it says in the Medtronic patient manual I was given when my pacemaker was inserted:

  • avoid rough physical contact that includes jarring or falling. Avoid skiing and playing football, baseball, and soccer if doing so involves rough physical contact
  • Avoid hunting if a rifle butt is rested on the same side as your pacemaker
  • Avoid any activity that involves pressing on your pacemaker
  • Also. . .
    • Tools and equipment that use electricity and magnets have electromagnetic fields around them. These fields are usually weak. Weak fields do not usually affect your pacemaker. However, strong electromagnetic fields can cause electromagnetic interference (EMI). EMI may alter temporarily how your pacemaker works. EMI can stop the pacemaker from sensing your heart's rhythm. This might stop the pacemaker from sending a pacing pulse. EMI could also cause the pacemaker to send a pacing pulse when your heart doesn't need it. Several safeguards are built into your Medtronic pacemaker to prevent EMI. Electronic filters can tell the difference between natural heartbeat signals and EMI signals. Also, the metal can around the pacemaker shields it from EMI. If you suspect your pacemaker is being affect by EMI, simply move away from the source of the EMI. Or, turn off the electrical device causing the EMI. Your pacemaker will then return to its normal operation.
    • Before undergoing any medical procedure, tell the doctor, dentist, or technician that you have a pacemaker. They may need to speak with your heart doctor before performing the procedure. Most dental and medical procedures are unlikely to interfere with your pacemaker. However, some procedures may require precautionary measures that prevent or minimize interference.
      • Diagnostic ultrasound - acceptable with precautions when the transducer is not directly over the pacemaker.
      • Therapeutic ultrasound - acceptable with precautions as the transducer must be kept 6 inches away from the pacemaker
      • electrolysis - acceptable if the applicator is kept 6 inches from the pacemaker and a grounding pad is used and placed on the same side of the pacemaker
      • mechanical ventilation - acceptable if the pacemaker has a sensor that detects changes in breathing, it must be turned off.

      [*]These procedures are not recommended with pacemakers

      • electrocautery
      • external defibrillation
      • a hearing aid with a coil around the neck
      • lithotripsy
      • radiofrequency ablation
      • radiation therapy - dependent on the amount of radiation to be received and the location
      • TENS
      • MRI scans
      • Diathermy

I was very worried about using the microwave when I first got my pacemaker. However, it has never been a problem. I just don't stand close to it. I was also told not to raise my arm and do any stretching with it on the pacemaker side as it could cause the lead wires to become dislodged in my heart which would then affect their ability to sense and deliver an electric pulse.

Hope that helps you. I didn't have time to check, but this information may also be on the Medtronic website.

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wow, thanks for all of the replies everybody!!!

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