A nurse is monitoring a client’s heart rhythm following the insertion of a permanent pacemaker.
Which of the following images should the nurse expect?
A.
A regular sinus rhythm.
B.
A chaotic, irregular rhythm.
C.
Absence of any electrical activity.
D.
A series of spikes followed by a QRS complex.
The Correct answer and Explanation is:
The correct answer is D. A series of spikes followed by a QRS complex.
Explanation:
After the insertion of a permanent pacemaker, the expected heart rhythm on an electrocardiogram (ECG) is characterized by a series of pacemaker spikes followed by a QRS complex. This is indicative of the pacemaker successfully stimulating the heart to contract.
Pacemaker Function: A pacemaker is a medical device that generates electrical impulses to maintain an adequate heart rate when the heart’s natural pacemaker (the sinoatrial node) fails to do so. The device is implanted under the skin, typically near the collarbone, with leads threaded into the heart to directly stimulate myocardial contraction.
ECG Interpretation: In a typical ECG tracing from a client with a permanent pacemaker, you will observe distinct vertical spikes (representing the electrical impulses generated by the pacemaker) preceding the QRS complexes. The presence of these spikes indicates that the pacemaker is functioning correctly. The QRS complex that follows indicates the ventricles are depolarizing and contracting, reflecting that the pacemaker’s impulse is successfully leading to ventricular activation.
Other Options Explained:
- A. A regular sinus rhythm: This would indicate the heart is functioning normally without the need for a pacemaker. Following pacemaker insertion, this is not expected unless the pacemaker is only temporarily needed.
- B. A chaotic, irregular rhythm: This suggests a lack of organized electrical activity, which could indicate arrhythmias, but it’s not what we expect with a functioning pacemaker.
- C. Absence of any electrical activity: This indicates asystole, which is a critical condition and suggests pacemaker failure or a very severe bradycardia.
In summary, following the insertion of a permanent pacemaker, the expected ECG would show spikes followed by QRS complexes, indicating effective pacing and contraction of the heart muscle.