H/P

Four hours after her arrival to the emergency department, the patient remains in second-degree type II heart block and her vital signs are stable. She is transferred to a telemetry unit to prepare for insertion of a permanent pacemaker later in the day. When she gets out of bed to use the restroom, she felt faint and had to sit on the floor. The nurse finds her sitting on the floor beside the commode; the patient is awake but somewhat confused. The patient is assisted back to bed. The nurse notes that the ECG monitor shows that the patient's heart rate is at 40 beats/minute and she is now in third degree heart block. The Rapid Response team is called, and preparations are made for the immediate application of a transcutaneous pacemaker (TCP).
Which nursing actions should be included in the plan of care for the patient (Select All that Apply.)

B. Continuous monitoring of vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, is essential for assessing the patient's hemodynamic status and response to treatment.

Additionally, continuous electrocardiographic (ECG) monitoring allows for real-time assessment of cardiac rhythm and conduction abnormalities.

C. This is an important nursing action to provide comfort and reduce anxiety for the patient. Transcutaneous pacing is often used as a temporary measure to stabilize heart rate and cardiac output until more definitive treatment, such as insertion of a permanent pacemaker, can be performed.

D. Atropine is another medication commonly used in ACLS protocols for symptomatic bradycardia and heart block. It acts to increase heart rate by blocking vagal tone. However, its effectiveness in third- degree heart block may be limited, and transcutaneous pacing is often the preferred intervention in this situation.

E. Correct placement of transcutaneous pacemaker pads is crucial for effective pacing. The pads should be placed on the chest over the heart to deliver electrical impulses and stimulate myocardial contraction. Proper placement ensures optimal pacing effectiveness and patient safety.

F. This nursing action addresses the patient's comfort and pain management following the placement of the transcutaneous pacemaker. The procedure may cause discomfort or pain, and appropriate analgesia should be provided to alleviate any discomfort and promote patient comfort.

A. Epinephrine is a medication commonly used in advanced cardiac life support (ACLS) protocols for bradycardia and heart block. In this scenario, the patient's heart rate has decreased to 40 beats/minute, indicating symptomatic bradycardia and potential hemodynamic instability. Epinephrine may be administered to increase heart rate and improve cardiac output.