About
Implantation of an electronic device into the anterior chest wall to terminate life threatening arrhythmias, especially severe tachycardias and ventricular dysrhythmias. Also used in patients at high risk of sudden cardiac death ( cardiomyopathies, ventricular dysrhythmias, prolonged QT syndrome).
Assess
Telemetry, ECG, vitals, pulse-oximetry, level of consciousness, patient understanding of procedure, informed consent, medication history, airway, incision site ( bruising, bleeding, redness, edema, drainage), pain levels
Complications
Infection, bleeding, hematoma, hemothorax, pneumothorax, equipment malfunction, pain, magnetic interference
Diagnosis
- Decreased cardiac output related to abnormal cardiac rhythm.
- Risk for infection related to invasive procedure.
- Risk for injury.
- Knowledge deficit related to procedure and treatment of arrhythmias.
Goals
- The client will maintain vital signs within normal parameters and pulse-oximetry above 94%.
- The client will state understanding of pre-, intra-, and post-operative instructions.
- The client will resume normal rhythms after evidence of ventricular dysrhythmias..
- The client will remain free from infection.
- The client will remain free from complications.
Interventions
- Assess ECG, vitals, pulse-oximetry continuously during procedure.
- Teach client what to expect pre-, intra- and post-procedure.
- Administer sedatives and anesthetic agents as prescribed.
- Maintain patent airway.
- Post-operatively, monitor VS every 15 minutes X 2, every 30 Minutes X 2, every 1 hour X 2, than every 4 hours ( may have different guidelines for each clinical agency).
- Assess device function by comparing device settings with ECG monitoring
- Monitor site, peripheral pulses, vitals, pain levels, respiratory status.
- Teach client activity restrictions ( no heavy lifting for a few weeks, restrict use of arm and do not raise above head for at least 2 weeks, avoid contact sports).
- Teach client to carry medical identification with device make, model, serial number, doctor name, and hospital where it was inserted and to call 911 if dizziness occurs as may be indication of device malfunction.
- Teach client potential complications to monitor for post-discharge ( magnetic interference, device malfunction, infection, bleeding) and when to return for immediate follow-up.
- Teach client to keep cell phones at least 6 to 12 inches away from implanted device.
- Teach client sources of magnetic fields to be avoided ( MRI, radio and TV transmission lines, overhead power lines, electrical substations, etc).
- Teach client that certain security screenings may be interfered with by implanted devices. Clients should carry medical identification and should avoid handheld screening devices.
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