A client with an implantable cardioverter defibrillator (ICD) develops ventricular tachycardia (VT) with a pulse while admitted to the medical-surgical unit. The ICD fires multiple times without successfully stopping the VT, causing the client to become confused and difficult to rouse. Which action by the nurse is appropriate?

Question

A client with an implantable cardioverter defibrillator (ICD) develops ventricular tachycardia (VT) with a pulse while admitted to the medical-surgical unit.  The ICD fires multiple times without successfully stopping the VT, causing the client to become confused and difficult to rouse.  Which action by the nurse is appropriate?

Quizplus · Accepted Answer

An implantable cardioverter defibrillator (ICD) is a medical device that is surgically implanted underneath the skin that can sense life-threatening arrhythmia and discharge electrical shocks directly into the cardiac muscle to correct the arrhythmia. Clients typically receive ICDs after a history of sustained or recurrent ventricular tachycardia (VT), including personal or family history of sudden cardiac death and severe heart failure. When caring for a client with an ICD, it is critical that the nurse monitor for ICD firings (eg, client report, observation on cardiac monitors). After firings, the nurse should monitor for resolution of the arrythmia, indications of hemodynamic compromise (eg, hypotension, chest pain, altered mentation), and additional ICD discharges. Occasionally, an ICD may be unable to convert the arrythmia to a hemodynamically stable rhythm and will repeatedly shock the client. If the client experiences repeated ICD shocks without dysrhythmia resolution, the nurse should promptly obtain a manual external defibrillator and initiate measures to prevent hemodynamic instability and cardiac arrest (Option D). (Option A) Stimulating a vagal response (eg, coughing) is an appropriate intervention for supraventricular tachycardia. (Options B and C) Deactivating the ICD and obtaining an ECG are not appropriate at this time because they delay lifesaving interventions. Educational objective: An implantable cardioverter defibrillator (ICD) is a device used to sense life-threatening arrhythmia and discharge electrical shocks to correct the arrhythmia. If a client experiences repeated ICD shocks without dysrhythmia resolution, the nurse should obtain a manual external defibrillator and initiate cardiac life support.

A Client with an Implantable Cardioverter Defibrillator (ICD) Develops Ventricular