A patient is being monitored by continuous ECG after placement of ...

[bclement10]

A patient is being monitored by continuous ECG after placement of a transvenous pacemaker. Loss of capture  is seen on the ECG. Which nursing intervention may correct this situation?
 
  a. Position the patient on the left side.
  b. Decrease the milliamperes as ordered.
  c. Increase the rate as ordered.
  d. Monitor the patient in a different lead.

Question 2

Which of the following choices is an acceptable and recommended method of noxious stimulation?
 
  a. Nipple pinch
  b. Nail bed pressure
  c. Supraorbital pressure
  d. Sternal rub

[brittiany.barnes]

Answer to Question 1

A
Loss of capture most often can be attributed either to displacement of the pacing electrode or to an increase in threshold as a result of drugs, metabolic disorders, electrolyte imbalances, or fibrosis or myocardial ischemia at the site of electrode placement. In many cases, increasing the output (mA) may elicit capture. For transvenous leads, repositioning the patient to the left side may improve lead contact and restore capture.

Answer to Question 2

B
Nail bed pressure and trapezius pinch are acceptable methods of noxious stimulation. Nail bed pressure allows evaluation of individual extremity function. Trapezius pinch is difficult to perform on large or obese adults. Repeated sternal rub can cause the sternum to become excoriated, open, and infected. Supraorbital pressure must be avoided in patients with head injuries, frontal craniotomies, or facial surgery. Nipple and testicle pinching are inappropriate and unnecessary.

[bclement10]

Thank you

[brittiany.barnes]

Happy to help you