CPR Renewal
Online Training
New NRP Class
Transvenous Pacing
September 16, 2008
For ACLS purposes, we are primarily concerned with two basic types of pacing. The first, transcutaneous pacing, is an emergent procedure which uses 2 gel pads. One is placed at the 5th intercostal space mid-clavicular on the left side of the anterior chest wall, and the other in between the backbone and shoulder blade on the left side of the back. The electricity travels through the pads and innervates the heart. This form of pacing is temporary. It is especially uncomfortable for the patient, and therefore should only be used as a means of maintaining stability in the bradycardic patient while attempting other interventions, such as drug therapy, or preparing for a more permanent transvenous pacemaker which causes no pain.
Types of Rhythms Where Pacing Is Indicated
• Bradycardias that are unresponsive to drug therapy or are symptomatic
• 2nd degree heart block type II
• 3rd degree heart block
Clinical Note:
Atropine may be given to 2nd degree type II heart block or a narrow complex 3rd degree heart block as a trial but, when detected, the American Heart Association ACLS guidelines recommend that these dysrhythmias be managed by immediate application of the transcutaneous pacer and close observation of the patient for any signs of hemodynamic instability, e.g., shortness of breath – hypotension – altered level of consciousness – chest pain – pallor – nausea & vomiting – profuse sweating. If unstable and in 2nd degree heart block type II or 3rd degree heart block, then the pacer should be used to correct the rate only until transvenous pacing can be accomplished by a qualified person.
Remember from earlier in the reading that if a patient is bradycardic and hemodynamically unstable, as described in the previous paragraph, then transcutaneous pacing should be considered as a first line treatment.
Setting a transcutaneous pacemaker will be discussed in the electrical therapy station on day 1 of ACLS
Three Basic Rhythms
There are 3 categories of abnormal rhythms: too fast, too slow or none. Patients with any dysrhythmia may be stable, unstable or in cardiac arrest. Recognizing which type of patient you have will decide your treatment choices: medicine, electrical, and/or mechanical (BLS).
Too Fast
The first rhythm is too fast. Our goal is to slow it down. We have two methods to slow down a rhythm: electrical therapy and/or medicine. If the patient is hemodynamically stable, pharmacology should be the first line treatment. If our patient were hemodynamically unstable, synchronized cardioversion should be the first line treatment.
Too Slow
The second rhythm is too slow. Our goal is to speed it up. We have two methods of speeding up a rhythm: electrical therapy and/or medicine. If the patient is hemodynamically stable, pharmacology should be the first line treatment. If our patient were hemodynamically unstable, transcutaneous pacing should be the first line treatment.
None
Ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity and asystole are the dysrhythmias associated with cardiac arrest. As these are lethal dysrhythmias, management must be quick and aggressive.
Grading and Academic Progress
August 11, 2008
| A | 90 – 100 | Excellent |
| B | 80 – 89 | Good |
| B | 80 – 89 | Good |
| C | 70 – 79 | Satisfactory |
| D | 60 – 69 | Poor |
| F | 0 – 59 | Failing |
The successful graduate must achieve a 70% score on all final written exams as well as 70% completion/competency on skills, ranging from basic care procedures to more complex procedures.
Since programs range from two to six weeks in total length, academic progress is noted by final exam or skills checklist only. Please see the failure policy below.
Failure Policy
Nursing Unlimited Health Career Training School policy is that students who do not complete a program, with the exception of Nursing Assistant Review, for any reason other than conduct, will be allowed to retake that program once at no additional cost. They will be admitted into the next class with space for them. Students who fail the written portion of the state CNA exam will be allowed to retake the Nursing Assistant Review class one time at no additional cost. Such students will be admitted into the next available class.
Admission Requirements
August 11, 2008
Nursing Unlimited Health Career Training School does not discriminate on the basis of race, color, nationality, or ethnic origin in its administration of educational policy and admissions policy. An applicant must be 18 years of age to enroll in the school.
All students must demonstrate competency in reading and writing English by achieving a score of 70% or better on Nursing Unlimited Health Career Training School’s Competency Exam. Students unable to demonstrate this required competency will be encouraged to enroll in a county public school ESOL program. The student may choose to be refunded their complete tuition at that time (see cancellation policy, page 28). Upon completion of the ESOL program, the student may return to enroll in the program of their choice.
Students enrolling must be physically able to perform the required functions for successful completion of the program. This includes sitting, standing, stooping, kneeling and lifting 25 lbs.
Nursing Unlimited Health Career Training School does not grant credit or advanced standing for previous education or training. Previous education must be proved only when registering for the Nursing Assistant Review course. This proof shall consist of certificates or diplomas from approved schools in the field of healthcare.
Reasons for denying admission to any prospective student shall be documented and kept on file for at least one year.
Our Purpose
The purpose of Nursing Unlimited Health Career Training School is to enable our students to acquire both the knowledge and the practical skills necessary to obtain gainful employment and to achieve their career goals within the healthcare industry.
Our Mission
Nursing Unlimited Health Career Training School continuously strives to provide an effective learning environment and opportunities for students interested in vocational training in the health care industry.
Our mission is to ensure continuous quality improvement in all areas in order to meet and exceed the needs of our students and the community at large.
TextBooks
August 11, 2008
Home Health Aide 40 Course Textbook
Sherron Newberry, RN
Nursing Unlimited, 2001
Home Health Aide 35 Course Textbook
Sherron Newberry, RN
Nursing Unlimited, 2001
Nursing Assistant Review Course Textbook
Paula E. Glass, RN, BSN
Nursing Unlimited, 2002
Phlebotomy Essentials, 3rd ed., 2003, Lippincott Williams and Wilkins
Ruth E. McCall and Cathee M. Tankersley
Career Development for Health Professionals, 2nd ed., 2006, Elsevier
Lee Haroun
EKG Workout: Exercises in Arrhythmia Interpretation, 5th ed., 2006,
Lippincott Williams & Wilkins
Jane Huff
Facilities and Equipment
August 11, 2008
Description of School Facilities
Nursing Unlimited Health Career Training School has approximately 6800 square feet, 50% of it devoted to actual classroom space. Formal instruction is provided in a modern, comfortable classroom setting designed especially for nursing skill education. The laboratory portion of classes takes place in classrooms that are similar to a working environment, complete with hospital bed, wheelchairs, walkers and other equipment utilized in a healthcare facility. It is here that students learn everything from bed making to taking blood pressure. All of the skills that are needed are practiced before the student is permitted to care for patients, and competency is graded, utilizing a skills competency checklist.
Nursing Unlimited’s media center measures approximately 256 square feet, and contains 6 computers and over 80 medical/nursing reference books and manuals. Additionally, we subscribe to numerous professional journals. Books, journals, a/v materials and laboratory equipment are regularly reviewed and updated as needed. Students have access to the media center at specified times, posted in the lobby. All faculty members have access to the media center to support the students’ education.
Inventory of Equipment
Laboratory equipment includes:
- Hospital beds
- Toothbrush/toothpaste
- Sink/ scale with height Over-the-bed tables
- Dentures/denture cup & personal care items Chux (bed protection pads)
- Bed linens Restraints
- Wheelchairs Walkers
- Gait / transfer belts Teaching (dual) & regular stethoscopes
- Emesis basins Lotion
- Bedside commodes Crutches
- Combs Full patient simulator mannequin
- Gloves Blood pressure cuffs & stethoscopes Canes Thermometers
- Orange stick/emery board Indwelling urinary catheters and collection bags
