Dual-chamber Rate-responsive pacemaker
Scenario: That afternoon, the patient is sent to the operating room and receives a dual-chamber rate-responsive pacemaker implanted via the left upper chest. The rate is set at 70 beats/minute.
Postoperatively, she is sent back to the telemetry unit. Vital signs: Blood pressure 122/84 mm Hg, pulse 70 beats/minute, respirations 18 breaths/minute, and temperature 98.4°F (36.9°C).
The ECG shows paced rhythm, rate 70 beats/minute.
The incision is covered with a light dressing.
The patient comments that she feels better with less fatigue. That evening, after dinner, the nurse reviews education about pacemakers with the patient and her spouse.
1. NGN Item Type: Matrix
Use an X for nursing actions listed below that are Indicated (necessary), Contraindicated (could be harmful), or Nonessential (not necessary). Only one selection can be made for each nursing action.
| Nursing Action | Indicated | Contraindicated | Nonessential |
| Encourage the patient to exercise the operative side after the pacemaker is inserted. | |||
| Check the patient’s ECG every 4 hours. | |||
| Instruct the patient to keep follow-up appointments for pacemaker checks. | |||
| Wash the incision site with soap and water twice a day. | |||
| Teach the patient to avoid the use of microwave ovens. | |||
| Instruct the patient to check her pulse and notify the HCP if the heart rate drops below 70 beats/minute. | |||
| Teach the patient to report any redness, drainage or swelling of the incision site. |
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