{
  "name": "Pacemaker Therapy",
  "slug": "pacemaker-therapy",
  "url": "https://nursingplex.com/care-plans/pacemaker-therapy",
  "category": "Cardiac",
  "summary": "Device implantation care with site checks, arm restrictions, capture monitoring and safety teaching.",
  "nursing_diagnoses": [
    "Risk for infection",
    "Decreased cardiac output",
    "Deficient knowledge"
  ],
  "overview": [
    "A permanent pacemaker delivers electrical impulses to maintain an adequate heart rate when the conduction system fails — symptomatic bradycardia, sick sinus syndrome, complete heart block or after AV node ablation. Leads are placed transvenously into the right atrium, right ventricle or both, with the generator in a subcutaneous pocket below the clavicle.",
    "The early risks are lead dislodgement, pocket hematoma or infection, and pneumothorax from subclavian access. Long term, patients need generator replacement, periodic interrogation and awareness of electromagnetic interference.",
    "Nursing care after implantation combines rhythm monitoring for capture and sensing, arm-movement restriction on the operative side, wound assessment, and thorough education so patients recognize device malfunction."
  ],
  "key_facts": [
    {
      "label": "Arm restriction",
      "text": "Avoid raising the arm on the implant side above the shoulder for the period ordered, usually several weeks."
    },
    {
      "label": "Failure to capture",
      "text": "Pacer spikes not followed by a QRS complex — report immediately."
    },
    {
      "label": "Failure to sense",
      "text": "Spikes appearing at inappropriate times risk R-on-T and ventricular arrhythmia."
    },
    {
      "label": "Interference",
      "text": "Keep cell phones on the opposite ear and side, avoid MRI unless the device is MRI-conditional, avoid arc welding and strong magnets."
    }
  ],
  "nursing_priorities": [
    "Verify appropriate pacing, sensing and capture.",
    "Prevent lead dislodgement.",
    "Monitor the incision for hematoma and infection.",
    "Detect pneumothorax after implantation.",
    "Educate the patient on device care, precautions and follow-up."
  ],
  "assessment": {
    "subjective": [
      "Reports of dizziness, palpitations, hiccups or fluttering sensation",
      "Complaints of pocket-site pain, swelling or pressure",
      "Reports of shortness of breath or chest pain",
      "Questions about activity, travel and airport security"
    ],
    "objective": [
      "ECG rhythm strip showing pacer spikes with appropriate capture and sensing",
      "Pulse rate at or above the programmed lower rate limit",
      "Incision site for swelling, hematoma, erythema or drainage",
      "Breath sounds bilaterally and post-implant chest x-ray for lead position and pneumothorax",
      "Diaphragmatic twitching suggesting lead migration"
    ],
    "related_factors": [
      "Surgical creation of a subcutaneous pocket and venous lead insertion",
      "Immature lead fixation in the first weeks",
      "Device malfunction, battery depletion or electrolyte disturbance",
      "Knowledge deficit about device precautions"
    ]
  },
  "goals": [
    "The client will maintain a heart rate at or above the programmed rate with appropriate capture.",
    "The client will remain free from infection and hematoma at the site.",
    "The client will demonstrate arm-movement restrictions correctly.",
    "The client will state device precautions and follow-up schedule."
  ],
  "interventions": [
    {
      "title": "Rhythm and device monitoring",
      "points": [
        "Maintain continuous ECG monitoring initially and evaluate strips for capture and sensing.",
        "Compare apical pulse with the programmed rate each shift.",
        "Report failure to capture, failure to sense, hiccups or diaphragmatic twitching.",
        "Monitor electrolytes, since imbalance alters pacing thresholds."
      ]
    },
    {
      "title": "Site and lead protection",
      "points": [
        "Immobilize the affected arm as ordered and avoid abduction above shoulder level.",
        "Assess the pocket for swelling, ecchymosis or expanding hematoma; apply pressure dressing per protocol.",
        "Keep the site clean and dry; watch for fever, warmth, redness or drainage.",
        "Auscultate lungs and review the post-procedure chest x-ray."
      ]
    },
    {
      "title": "Education and follow-up",
      "points": [
        "Teach daily pulse checks and the programmed lower rate limit.",
        "Provide the device identification card and explain airport and hospital notification.",
        "Review electromagnetic interference sources and the MRI restriction.",
        "Arrange remote monitoring or clinic interrogation appointments."
      ]
    }
  ],
  "patient_teaching": [
    "Check the pulse daily and report a rate below the set limit.",
    "Avoid heavy lifting and overhead arm movement on the implant side until cleared.",
    "Carry the device card at all times and inform every provider, especially before MRI or surgery.",
    "Report fever, site redness or drainage, dizziness, fainting or prolonged hiccups."
  ]
}