Health Promotion and Maintenance Q 128
The client with a pacemaker should be taught to:
A. Report ankle edema
B. Check his blood pressure daily
C. Refrain from using a microwave oven
D. Monitor his pulse rate
Correct Answer: D. Monitor his pulse rate
The client with a pacemaker should be taught to count and record his pulse rate. Pacemakers are adjustable artificial electrical pulse generators, frequently emitting a pulse with a duration between 0.5 and 25 milliseconds with an output of 0.1 to 15 volts, at a frequency up to 300 times per minute. The cardiologist or pacemaker technologist will be able to interrogate and control the pacing rate, the pulse width, and the voltage, whether the device is temporary or permanent.
Option A: Ankle edema is a sign of right-sided congestive heart failure. Although this is not normal, it is often present in clients with heart disease. If the edema is present in the hands and face, it should be reported. The pacing and CRT are associated with complications. The majority of complications occur in the hospital or during the first 6 months. Lead complications are the main reason for the re-implantation of the pacemaker and CRT devices. Other complications include, but are not limited to infections, hematoma formation, pericardial effusion or tamponade, pneumothorax, coronary sinus dissection, or perforation. Some old pacemakers are not MRI safe.
Option B: Checking the blood pressure daily is not necessary for these clients. Patients who eventually require permanent pacemaker implantation often present with symptoms of dizziness, lightheadedness, fatigue, syncope, or lack of exercise tolerance. Frequently, these symptoms arise from bradyarrhythmias and patients will have sinus node dysfunction or atrioventricular (AV) conduction defects.
Option C: The client with a pacemaker can use a microwave oven, but he should stand about 5 feet from the oven while it is operating. There are some areas where the indications for a pacemaker are clear, but there are few areas where clinical judgment and expertise plays a greater role. Although the guidelines attempt to define practices that meet the needs of most patients, the ultimate decision for the patient should be based on the particular patient presenting the scenario, clinician judgment, and discussion with the patient about risks and benefits of the procedure.