Page 1693 - Saunders Comprehensive Review For NCLEX-RN

and is used when the client is asystolic or profoundly
bradycardic.
3. Overdrive pacing suppresses the underlying rhythm
in tachydysrhythmias so that the sinus node will
regain control of the heart.

C. Spikes

1. When a pacing stimulus is delivered to the heart, a
spike (straight vertical line) is seen on the monitor or
ECG strip.
2. Spikes precede the chamber being paced; a spike
preceding a P wave indicates that the atrium is paced,
and a spike preceding the QRS complex indicates that
the ventricle is being paced.
3. An atrial spike followed by a P wave indicates atrial
depolarization, and a ventricular spike followed by a
QRS complex represents ventricular depolarization;
this is referred to as capture.
D. Temporary pacemakers
1. Noninvasive transcutaneous pacing
a. Noninvasive transcutaneous pacing is
used as a temporary emergency
measure in the profoundly bradycardic
or asystolic client until invasive pacing
can be initiated.
b. Large electrode pads are placed on the
client’s chest and back and connected
to an external pulse generator.
c. Wash the skin with soap and water
before applying electrodes.
d. It is not necessary to shave the hair or
apply alcohol or tinctures to the skin.
e. Place the posterior electrode between
the spine and left scapula behind the
heart, avoiding placement over bone.
f. Place the anterior electrode between V2
and V5 positions over the heart.
g. Do not place the anterior electrode over
female breast tissue; rather, displace
breast tissue and place the electrode
under the breast.
h. Do not take the pulse or BP on the left
side; the results will not be accurate
because of the muscle twitching and
electrical current.
i. Ensure that electrodes are in good
contact with the skin.
j. Set pacing rate as prescribed; establish

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