Page 1690 - Saunders Comprehensive Review For NCLEX-RN

4. Postprocedure interventions

a. Priority assessment includes ability of
the client to maintain the airway and
breathing.
b. Resume oxygen administration as
prescribed.
c. Assess vital signs.
d. Assess level of consciousness.
e. Monitor cardiac rhythm.
f. Monitor for indications of successful
response, such as conversion to sinus
rhythm, strong peripheral pulses, an
adequate BP, and adequate urine
output.
g. Assess the skin on the chest for
evidence of burns from the edges of
the pads.
C. Defibrillation
1. Defibrillation is an asynchronous countershock used
to terminate pulseless VT or VF.
2. The defibrillator is charged to 120 to 200 joules
(biphasic) or 360 joules (monophasic) for 1
countershock from the defibrillator, and then CPR is
resumed immediately and continued for 5 cycles or
about 2 minutes.
3. Reassess the rhythm after 2 minutes, and if VF or
pulseless VT continues, the defibrillator is charged to
give a second shock at the same energy level
previously used.
4. Resume CPR after the shock, and continue with the
life support protocol.

Before defibrillating a client, be sure that the oxygen is shut off

to avoid the hazard of fire and be sure that no one is touching the bed or
the client.
D. Use of pad electrodes
1. One pad is placed at the third intercostal space to the
right of the sternum; the other is placed at the fifth
intercostal space on the left midaxillary line.
2. Apply firm pressure of at least 25 lb to each of the
pads.
3. Be sure that no one is touching the bed or the client
when delivering the countershock.
4. Pads for hands-off biphasic defibrillation may be
applied in an anterior-posterior position or apex-

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