Medical Surgical EKG #9

Question

A client is being discharged following insertion of a permanent pacemaker. The nurse determines that the client requires further instruction on safety precaution after the following statement:

Answers

  1. “I will avoid having radiological Magnetic Resonance Imaging”
    • Rationale:

      This answer is not correct because the client does not need further instruction on safety precautions because they understand to avoid radiological Magnetic Resonance Imaging. MRIs should be avoided as the strength of the magnet in the device would cause the pacemaker to malfunction.

  2. “I understand that initially, the site may be slightly bruised, swollen, and tender”
    • Rationale:

      This answer is not correct because the client does not need further instruction on safety precautions because they understand that initially, the site may be slightly bruised, swollen, and tender. Instructions may include gentle washing of incision site, and not applying lotion or powder.

  3. “I can lift the farm gate that weighs 20 pounds once I get home and settled”
    • Rationale:

      This answer is correct because a new pacemaker requires limitation of physical activity, including no lifting, pulling, or pushing more than 5 pounds. The client will need to have further education if they speak of lifting more than 5 pounds.

  4. “I will not raise my affected arm close to the site above the level of my heart for the first couple of weeks.”
    • Rationale:

      This answer is not correct because the client does not need further instruction on safety precautions because they understand they should not raise the affected arm close to the site above the level of my heart for the first couple of weeks. This precaution will help the client not displace the wires of the pacemaker.

Overview

A new pacemaker requires limitation of physical activity, including no lifting, pulling, or pushing more than 5 pounds, so the client will need to be educated further if they speak of lifting something greater than 5 pounds.

Explanation

Learning Outcomes

A new pacemaker requires limitation of physical activity, including no lifting, pulling, or pushing more than 5 pounds. Other limitations include limiting tasks like sweeping in repetitive motions, keeping the area free from pressure (such as tight clothing or suspenders), and not raising the arm on the affected side above the level of the heart for the first few weeks. The pacemaker insertion site may be bruised, swollen, tender, and instructions may include gentle washing of incision site, and not applying lotion or powder.

Test Taking Tip

Discharge teaching, especially surgery or procedures, is extremely important because the intervention does not need to be undone or damaged due to lack of knowledge regarding limitations that are in place to protect the client and reduce the risk of un-doing the treatment received.

Video Rationale