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Pacemaker/ICD Case Study Answers

Mr. Wesley Black is brought to the emergency department by ambulance following an episode of syncope at a local restaurant. The nurse is assessing the client. Mr. Black reports for the past 22 weeks he has been experiencing weakness. He states, “It is getting so hard for me just to get my mail form the mailbox now. I don’t know what is wrong with me.” The nurse assesses the following vital signs: temperature is 98.6 F, pulse rate is 50 and regular, respirations are 28 breaths per minute, and blood pressure is 88/54. Mr. Black acknowledges that he is feeling anxious. The client has the following rhythm:

1. What is the rhythm shown?

2. What other questions would you like to ask Mr. Black as part of your initial assessment?

3. It is determined that Mr. Black will require a permanent pacemaker (PPM). What is the outcome of having the pacer placed? Will it correct the underlying problem?

4. What preoperative instructions will you give Mr. Black regarding placement of his pacemaker? What postoperative activity and instructions will you provide to Mr. Black? He states, “I have always heard you cannot get near a microwave oven. Is this true… Are there any other precautions around machinery that I need to follow?”

5. What are common complications following a pacemaker insertion that you need to assess for?

6. You admitted a client, Mr. Smith, who had the following rhythm for a period of time. He is now normal sinus rhythm. The client is scheduled for an AICD insertion. What is the rhythm below? How will an AICD help this patient?

-What is the rhythm?
-Explain AICD?
-Benefits of AICD?

7. What are some indications for a pacemaker?

8. Study the following rhythms, identify the rhythm and indicate possible causes and treatment.

9. Identify the following rhythms.








10. What are the differences between synchronized cardioversion and defibrillation?












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