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Course # 90802 • Antibradycardia Pacemakers

Overview

The clinical management of the individual requiring pacemaker therapy occurs across a range of settings. Frequently, the patient's need for a pacemaker is identified when the patient presents to a physician's office, ambulatory care setting, or emergency department with a complaint of frequent dizziness, syncopal or near-syncopal episodes, unexplained falls, or increasing signs of heart failure. Implantation of the pacemaker occurs in an acute care setting, where the patient's clinical status and pacemaker function are closely monitored for a short period. Long-term follow-up generally occurs in physicians' offices or ambulatory care settings. Using the recommendations published by the American College of Cardiology Foundation and the American Heart Association, medical indications will be outlined. Preoperative, immediate postoperative, and long-term follow-up care for patients undergoing permanent pacemaker implantation will be discussed. Emphasis will be placed on patient education. Topics that will be covered include safe use of home appliances and the issues of electromagnetic interference from sources such as airport security, commercial antitheft devices, cellular phones, and others. The use of biventricular pacemakers/cardiac resynchronization therapy (CRT) for persons with severe heart failure will be explored. Finally, application of the content will be provided through detailed case studies.

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Education Category: Medical / Surgical

Release Date: 09/01/2017

Expiration Date: 08/31/2020

Audience

This course is designed for physicians, nurse practitioners, and nurses practicing in acute or adult healthcare settings.

Accreditations/Approvals

In support of improving patient care, NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NetCE is approved to offer continuing education through the Florida Board of Nursing Home Administrators, Provider #50-2405. NetCE is approved by the California Nursing Home Administrator Program as a provider of continuing education. Provider number 1622. NetCE is accredited by the International Association for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU. This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. The course is approved for 15 CE contact hour(s). Activity code: H00031454. Approval Number: 180001131. To claim these CEs, log into your CE Center account at www.ccmcertification.org.

Designations of Credit

This activity was planned by and for the healthcare team, and learners will receive 15 Interprofessional Continuing Education (IPCE) credit(s) for learning and change. NetCE designates this enduring material for a maximum of 15 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 15 ANCC contact hour(s). NetCE designates this continuing education activity for 18 hours for Alabama nurses. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 15 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Completion of this course constitutes permission to share the completion data with ACCME. This home study course is approved by the Florida Board of Nursing Home Administrators for 5 credit hour(s). This course is approved by the California Nursing Home Administrator Program for 10 hour(s) of continuing education credit - NHAP#1622010-6091/P. California NHAs may only obtain a maximum of 10 hours per course. NetCE is authorized by IACET to offer 1.5 CEU(s) for this program. AACN Synergy CERP Category A.

Individual State Nursing Approvals

In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, (valid through November 21, 2017); Alabama, Provider #ABNP0353, (valid through November 21, 2021); California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Iowa, Provider #295; Kentucky, Provider #7-0054 through 12/31/2019; South Carolina, Provider #50-2405.

Special Approvals

This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.

Course Objective

Pacemakers are being used with increasing frequency in the United States, and healthcare professionals are likely to encounter patients for whom pacemakers may be indicated. The purpose of this course is to provide basic information on pacemaker therapy, indications for implantation, preprocedure and postprocedure care, identification and management of pacemaker malfunctions, and patient education.

Learning Objectives

Upon completion of this course, you should be able to:

  1. Describe the incidence, history, and trends in permanent pacemaker therapy for adults.
  2. Review normal cardiac conduction.
  3. Describe the basic components of an antibradycardia pacemaker system.
  4. Outline the basic and advanced pacemaker functions.
  5. Discuss five-digit pacemaker coding systems.
  6. Discuss the features of single and dual chamber atrial and ventricular demand pacemakers.
  7. Review symptomatic bradycardia and sinus node dysfunction indications for permanent pacemaker implantation in adults.
  8. Discuss second- and third-degree atrioventricular (AV) block as indications for permanent pacemaker implantation.
  9. Identify other potential indications for permanent pacemaker implantation.
  10. Describe key aspects of patient history that should be included in the diagnosis and evaluation of a patient for permanent pacemaker implantation.
  11. Discuss diagnostic tests used in the evaluation of a patient for permanent pacemaker implantation.
  12. List factors that should be considered in the selection of a specific type of pacemaker for an individual patient.
  13. Briefly describe the preprocedure care and implantation procedure for permanent pacemakers.
  14. Identify key points involved in monitoring pacemaker function in the postimplantation period.
  15. List key components of discharge education and follow-up care for a patient following permanent pacemaker insertion.
  16. Discuss identification and management of common pacemaker problems including end-of-battery life indications, failure to sense, failure to fire, and failure to capture.
  17. Review pacemaker syndrome, including signs and symptoms, underlying cause, and management.
  18. Describe the management of patients requiring biventricular pacemakers for cardiac resynchronization therapy (CRT), including indications for use and patient monitoring.

Faculty

Karen Majorowicz, RN, ARNP, is currently employed in the Cardiac Intermediate Care Unit at Shands Healthcare at the University of Florida, Gainesville. She received her Master's in Medical-Surgical Nursing in 1978 from the University of Maryland. Karen has created numerous instructional manuals on Medicare and has conducted educational programs on cardiovascular assessment. She was a curriculum and instructional design consultant to the Institute for Child Health Policy, University of Florida, for a self-paced instructional module of SSI Disability for children.

Faculty Disclosure

Contributing faculty, Karen Majorowicz, RN, ARNP, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planners

John M. Leonard, MD

Jane C. Norman, RN, MSN, CNE, PhD

Division Planners Disclosure

The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Technical Requirements

Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported. Supported browsers must utilize the TLS encryption protocol v1.1 or v1.2 in order to connect to pages that require a secured HTTPS connection. TLS v1.0 is not supported.

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