The nurse is caring for a client who just had a permanent ventricular pacemaker inserted. The nurse observes the cardiac monitor and sees a pacing spike followed by a QRS complex for each heartbeat. How should the nurse assess for mechanical capture of the pacemaker?

Question

The nurse is caring for a client who just had a permanent ventricular pacemaker inserted.  The nurse observes the cardiac monitor and sees a pacing spike followed by a QRS complex for each heartbeat.  How should the nurse assess for mechanical capture of the pacemaker?

Quizplus · Accepted Answer

Clients with an implanted permanent pacemaker should be assessed for both electrical capture of heart rhythm and mechanical capture of heart rate. In atrial pacing, pacer spikes precede P waves, whereas in ventricular pacing, pacer spikes precede QRS complexes. Pacing spikes should be immediately followed by their appropriate electrical waveform, indicating electrical capture. Checking for mechanical capture is essential to ensure that the electrical activity of the heart corresponds to a pulsatile rhythm. The best method for checking for a pulsatile rhythm is to assess a central pulse (eg, auscultation of apical, palpation of femoral) (Option A). This rate should be compared to the electrical rate displayed on the cardiac monitor to assess for pulse deficit. (Option B) Blood pressure is an important assessment relating to cardiac output and organ perfusion, but it does not determine if the client's pacemaker is capturing the mechanical activity of the heart. (Option C) A 12-lead ECG does not assess mechanical capture of cardiac activity via the client's pacemaker. (Option D) Peripheral pulses (eg, radial, pedal, popliteal) are not the best indicators of mechanical action of the heart. Peripheral vasculature may have anatomical changes that impair pulse quality, leading to false perception of a pulse deficit. Educational objective: For clients with a newly implanted permanent pacemaker, the nurse should assess for electrical capture of heart rhythm (eg, ECG) and mechanical capture of heart rate (eg, pulse). A central pulse (eg, auscultation of apical, palpation of femoral) should be assessed to determine mechanical capture.

The Nurse Is Caring for a Client Who Just Had