NCLEX RN Practice Question 432

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Implantable cardioverter-defibrillator (ICD)

 Description

• An ICD monitors cardiac rhythm and detects and terminates episodes of VT and VF.
• The ICD senses VT or VF and delivers 25 to 30 J up to four times, if necessary.
• An ICD is used in clients with episodes of spontaneous sustained VT or VF unrelated to an MI or in clients whose medication therapy has been unsuccessful in controlling life-threatening dysrhythmias.
• Transvenous electrode leads are placed in the right atrium and ventricle in contact with the endocardium; leads are used for sensing, pacing, and delivery of cardioversion or defibrillation.
• The generator is most commonly implanted in the left pectoral region.

Client education

• Instruct the client in the basic functions of the ICD.
• Knowthe rate cutoff of the ICD and the number of consecutive shocks that it will deliver.
• Wear loose-fitting clothing over the ICD generator site.
• Avoid contact sports to prevent trauma to the ICD generator and lead wires.
• Report any fever, redness, swelling, or drainage from the insertion site.
• Report symptoms of fainting, nausea, weakness, blackouts, and rapid pulse rates to the physician.
• During shock discharge, the client may feel faint or short of breath
• Instruct the client to sit or lie down if he or she feels a shock and to notify the physician.
• Advise the client to maintain a log of the date, time, and activity preceding the shock, the symptoms preceding the shock, and postshock sensations.
• Instruct the client and family in how to access emergency medical system.
• Encourage the family to learn CPR.
• Instruct the client to avoid electromagnetic fields directly over the ICD because they can inactivate the device.
• Instruct the client to move away from the magnetic field immediately if beeping tones are heard, and to notify the physician.
• Keep an ICD identification card in the wallet and obtain and wear a Medic-Alert bracelet.
• Inform all health care providers that an ICD has been inserted; certain diagnostic tests, such as an MRI, and procedures using diathermy or electrocautery interfere with ICD function.
• Advise the client of restrictions on activities such as driving and operating dangerous equipment.