1a. What nursing management should the nurse provide immediately?
Swelling of the arm after pacemaker surgery is a normal but rare occurrence. This swelling is caused by a blood clot that develops in the veins on which the pacemaker is fitted. Swelling usually goes down within a few days, although the nurse can offer anticoagulant medication to prevent this clot from growing in size. The nurse should also constantly monitor electrocardiograms (ECG) for any changes in rate or abnormal rhythms and give treatment where necessary.
1b. Explain the general care of the patient after receiving an implanted pacemaker.
Managing a patient of a patient after surgery involves mandatory bed rest for twelve hours and preventing any movement of the affected arm. Assess whether the patient experiences any pain and provide painkillers if necessary. The nurse should monitor the state of the insertion site and make sure there is no bleeding or infection. Any swelling is treated by the application of icepacks. The patient should engage in a range of motion (ROM) after 24 hours have passed. The nurse should avoid giving the patient aspirin or heparin within 48 hours.
2a. What action should the nurse take first?
The nurse is supposed to assess the pulse of the patient first. This action is meant to determine whether the patient is displaying pulseless VT or not by checking the patient’s pulses. Defibrillation and CPR is the most appropriate form of action after this assessment. Intravenous drug administration follows after, along with the administration of oxygen. Defibrillation should, however, not be the first result in cases where the patient is conscious.
2b. The nurse notes the patient has no pulse, and tells someone to get the code cart and another to call the hospital’s code team. Upon arrival of the code cart, the nurse prepares the defibrillator for use. At what energy level does the nurse set the biphasic defibrillator for the first shock?
Guidelines for using a defibrillator state that initial energy settings should be between 150 and 200 joules. Subsequent energy shocks are supposed to be set to at least 360 joules.
2c. After defibrillation, the nurse assesses the patient, finds him pulseless, and initiates cardiopulmonary resuscitation. The code team has arrived, and epinephrine is administered. What is the rationale for this medication in this emergency situation?
Epinephrine drug is usually administered during CPR to help reverse the process of cardiac arrest since it increases cerebral and myocardial blood flow. The drug increases the rate and force of contraction by constricting blood vessels.
2d. What is the difference between monophasic and biphasic defibrillators?
Monophasic defibrillators work by delivering electric current in a single direction from one side of the chest, while Biphasic defibrillators deliver this shock in two directions.
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