Effects of Living With A Pacemaker

Effects of Living With A Pacemaker Mackenzie Crowe Millions of people live with the help of a pacemaker on a day to day basis. An enormous 600,000 pacemakers are implanted each year and a total of 3 million people worldwide are living with a pacemaker.1 Like most scenarios, health hazards do not really affect someone until a family member or close friend is diagnosed. We usually do not become curious until someone we truly care about requires some sort of help. That’s just what my family member’s heart needed. My family member lived with a pacemaker quite a few years before he passed. Along with his age, he had other health complications that lead to arrhythmias, or irregular heartbeats, and his body became too weak to keep up with the demand of pumping blood to all parts of the body; so they implanted a pacemaker. A pacemaker, also known as an implantable cardioverter defibrillator (ICD), is a miniaturized computer that sends electrical stimulation to the heart whenever it senses that the heart is not beating or is beating too slowly.2 The pacemaker is about the size of two stacked silver dollars and weighs approximately 17-25 grams.2 This device’s main purpose is to help the heart maintain its repetitive rhythm, but it can also store information for a doctor to retrieve which will allow the best possible therapy per individual.2 Newer pacemakers can also treat heart failure by resynchronizing the electrical impulses in the heart’s four chambers- therefore improving the hear t’s ability to pump blood.2 From the time my family member had one implanted to the time that he passed, he had gone through two pacemakers. Like anything else, pacemakers can malfunction. In my family member’s case, his pacemaker just wasn’t working properly and so they just simply implanted a new one. From then on, everything pertaining to his pacemaker went rather smoothly. When I was young my cousins and I always asked him questions as to why he had it, what it did for him, and sometimes he would even open his shirt and let us feel where the pacemaker was in his chest. Although I didn’t live with my grandparents I did spend a lot of time at their house and the fact that my family member had a pacemaker rather bothered me. I wanted to know everything about it. I wanted to know what to do if something were to go wrong. I wanted to know if there could be complications that others needed to be aware of. I wanted to know that having a pacemaker wasn’t going to prohibit him from doing normal daily activities. As I spent more time with him and did some research of my own, I learned a lot more about pacemakers. I learned what it’s like to live with someone who has one compared how an individual’s life can change from getting a pacemaker implanted. This paper aims to help the reader understand exactly what a pacemaker is, and what it does for someone. The reader will also learn about problems associated with having a pacemaker, latest trends and treatments, and trends in nutrition, which will include medication(s). I also hope to see the reader understand how a family can be affected by living with someone who has a pacemaker, and how caring and monitoring a person with a pacemaker can be difficult at times. In a medical aspect, this paper will connect pacemakers and dentistry together. The reader will learn of risks associated to pacemakers in a dental office, dental implications, dental complications, and how to educate a patient of good oral hygiene with the use of pacemaker in place. I have also attempted to identify important questions for the patient and what to do in the instance of an emergency. Due to the vast amount of pacemakers used throughout the United States, researching and learning about pacemakers will help me be prepared for the evaluation of a patient with this medical history. I know that as a dental hygiene student it is my responsibility to be prepared for patients that present items that could interfere with the dental practice and be ready to make modifications as needed. As a health professional it is also my job to put the health of that patient at the forefront of my care plan when preparing for treatment. A pacemaker is not to be confused with the heart’s natural pacemaker. This artificial medical device uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beat of the heart.3 Its primary purpose is to keep the heart beating adequately, either because the natural heart is not fast enough, or there is a block in the electrical conduction system. Some pacemakers are combined with a defibrillator in a single device, while others have multiple electrodes stimulating different positions within the heart to help improve irregularity of the lower chambers of the heart.3 Pacemakers are a necessity for many people. Millions of people wouldn’t be able to participate in day to day activities if not for their pacemaker. Pacemakers give a sense of normality to those who would otherwise be struggling to complete an activity that seems so easy to someone whose heart functions fine without assistance. Some complications with pacemakers during or after implantation (acute) could be bleeding, infection at implantation site, allergic reaction, swelling, or a collapsed lung, all of which are uncommon and can be treated easily and effectively.4 Later complications (chronic) can be generator failure and lead failure, both of which are extremely rare.5 If patients follow a precise routine of physician care appointments, most complication can be detected before becoming serious. Patients should be aware of symptoms such as weakness, being easily fatigued, lightheadedness, dizziness, and loss of consciousness.5 If these symptoms appear after implantation, the patient’s doctor should be notified immediately so that the pacemaker can be checked in correspondence with these symptoms. Patients with pacemakers should try to adhere to a heart healthy diet after the implantation process in order to have a successful and quick recovery. This type of diet includes low fat and low simple sugars and high fiber contents.6 The patient’s diet should also be based on height, weight, current diet pattern, medical history, and level of physical activity. Family members who are in the role of caretaking for post-surgery patients should encourage the patient to try and maintain their current weight or lose weight is the patient is considered overweight by a physician. They should emphasize eating whole foods such as whole cereals, grains, beans, and fresh fruits and vegetables.6 Proteins such as eggs, milk, fish high in omega-3 fatty acids, and poultry should also be included.6 Fatty foods, fried and salty foods, sweets, or bakery items like cookies and cakes, along with carbonated beverages should be avoided.6 The patient should also try to avoid any kind of stress wheth er is it physical or psychological, and they should take further measures to quit smoking.6 If the patient drinks alcoholic beverages, it can be continued but should be done in moderation such as limiting it to one per day or as otherwise discussed with the physician.6 Most pacemakers now allow for patients to get engaged in physical activities which is an important aspect in congruence with a healthy diet. Exercise will not only help maintain body weight, but it will also help improve the patient’s cholesterol.6 Before beginning any physical activity, exercise should be discussed with the patient’s specialist or dietician. Family members are the best advocate to help keep the patient on track and in line with multiple aspects of their diet, stress levels, smoking, and physical activity. As of now, no drugs are used along with a pacemaker because treatment consist of upgrading or reprogramming the pacemaker. Sometimes medications are given to the patient when the implantation process begins so that they patient is able to relax but still be aware of their surroundings.7 They will still be able to hear and talk to the medical team throughout the process. The patient will also receive anesthetic (numbing) medication at the site of the incision.7 Certain patients with atrial flutter/fibrillation or venous problems may be on medications such as Coumadin or patients that have had previous stent replacement may be on Plavix to reduce the chances of blockage.8 These medications are not normally prescribed after implantation but if the patient is already taking them before implantation they are normally switched over to a Heparin IV drip for surgery and then slowly moved back over to their medications afterward.8 Caring for patients with pacemakers can be difficult if the patient does not value their health as much as they should. It can be hard to take care of someone who would rather let the caretaker do all the work. Patients should be motivated to stay healthy. While most know that this is easier said than done, family members should try to emphasize a healthy diet and how it can really make a difference in their daily living. Elderly patients will need more recuperation time and won’t be able to participate in strenuous activity like a middle aged patient. It is imperative that the caregiver try to get the patient to be self-sufficient so that when the time comes for them to take care of themselves, they will know where to take off from what their caregiver was doing for them. The implantation of a pacemaker can affect the patient’s ability to undergo various medical procedures. Dental procedures, X-rays, MRI’s, CAT scans, bone density tests, mammograms, and ultrasounds can all affect pacemakers because of the reactions of the energy waves involved in the tests and the electronic component of the pacemaker.9 If the pacemaker is not programmed to resists these types of interferences, complications can arise. Dental care, like any specialized treatment, is a necessary and routine healthcare issue. Most dental care visits include x-rays, ultrasonic scaling, drilling, and other procedures that might produce high electromagnetic energy. To avoid malfunctions to the pacemaker and possible harm to the patient, it is extremely important to tell the clinician about the pacemaker in advance. The oral cavity is a likely source of bacteria that may elicit infections on pacemaker and ICD devices after systemic transmission.10 According to the American Dental Association, studies show that dental patients with a pacemaker are particularly at risk for developing endocarditis.11 This infection or inflammation of the heart occurs as a result of bacteria that enters the bloodstream from the mouth.11 Under certain conditions, patients with heart problems will be given antibiotic medications before procedures to help prevent bacteria from spreading to the bloodstream.11 This is a proactive approach that protects the patient and the dentist. Certain dental procedures often involve the use of electrical equipment that may come into close proximity to an implanted pacemaker. There is a possibility that exposure to some of this equipment may temporarily affect the function of the pacemaker. Some potential interactions that might take place are: inhibition of pacing: pacing not provided when needed, asynchronous pacing: pacing provided at a fixed rate whether needed or not, and inappropriate shocks: shock therapy provided when not needed.12 Some manufacturers contraindicate product use in patients with pacemakers, but there are also other things that can be done to avoid complications.12 The clinician should seat patients away from power sources or adjust equipment to the lowest possible setting and should also avoid draping cables over the implantation site.12 If the patient begins to feel lightheaded, have increased heart rate, experiences a shock, or hears beeping from their device they should move away from the source of interference or the clinician should power down the device.12 This will allow for the pacemaker to return to normal. According to the Boston Scientific Analysis of Dental Equipment, drills and cleaning equipment, dental x-rays, and apex locators all showed no signs of interference.12 Ultrasonic scalers can cause disturbances but are very unlikely unless notified by the manufacturer.12 To be on the safe side, the majority of dentists would not use an ultrasonic scaler to perform a scale in a patient fitted with a pacemaker or an implantable cardiac defibrillator (ICD).13 Other dental office equipment that may cause interferences are dental chairs with magnetic headrests and electrocautery.12 Both are temporary affects although if patient’s pacemaker is programmed not to respond to magnetic headrests then patients may sit in these chairs.12 Patients considered to be at risk from external interference can have a magnet placed over the pacemaker to switch the pacemaker to fixed-rate mode making it immune to external signals.14 Use of mini magnets in prosthetic dental procedures is safe for patie nts with implanted pacemakers.15 Clinicians should be prepared to make accommodations for patients that have pacemakers. The use of hand instruments will be critical if a patient shows signs of being sensitive to electrical devices. It is the job of the clinician to be able to adapt to that patients’ needs rather than making the patient adapt to the office; this includes helping the patient make changes at home as well. Some patients with pacemakers may need assistance when it comes to good home care. The patient will most likely need accommodations to be made shortly after surgical implantation. It may be hard for the upper chest and dominant hand to move a toothbrush around the oral cavity. Clinicians should be aware of this need and should be ready to make suggestions based on the individual. Some ideas that may be beneficial are having another person brush for the patient for the first few days after the surgery. If the patients then feels better suited to take over they could begin brushing once a day along with a mouth rinse and slowly move up to brushing twice a day and flossing when they feel fit to do so. This may be easier for the patient and at the same time they are still accomplishing good oral health care. Before beginning treatment in a dental office the patient should make sure that their clinician knows of their personal health status with their pacemaker included and that their clinician is prepared if an emergency would arise. It’s best to have a clinician certified in CPR and that is knowledgeable on how to use an automated external defibrillator (AED) if necessary. CPR chest compressions can be done as usual on a patient with an implanted pacemaker.16 Implantable pacemakers are also designed to withstand the shock of an external defibrillator but the pads should not be placed over the device or the pacemaker can sustain damage.16 If the patient has an implanted medical device, an alternative AED pad position is advised, such as the anterior-posterior position.17 It is best to place the pads as far from the source of the pulse as possible and to use the lowest power clinically acceptable to try and deliver a shock that will not damage the device but will restart the patien t’s heart.16 Pacemakers are a vital source of life for many Americans. They enable people to keep living a normal lifestyle. Although there will always be aspects that patients can do to sustain better care for themselves, having a pacemaker is really quite easy. Monitoring the device is important and routine doctor visits are necessary for upkeep and general health. My family member was able to go on living his life as he normally would’ve because he had the help of his pacemaker. Without that, I may not have had as much time with him as I was able to have, and for that I am truly grateful. Modern technology is continually growing and the pacemaker system is developing with it. I hope that this paper gives you a general knowledge about pacemakers, health importance at home and with family members, and their connection to the dental office. Sources Available at: http://circ.ahajournals.org/content/105/18/2136.full. Accessed November 9, 2013. Available at: http://health.sjm.com/arrhythmia-answers/treatment-options/implantable-devices/pacemaker. Accessed October 9, 2013. Available at: http://en.m.wikipedia.org/wiki/Artificial_pacemaker. Accessed March 14, 2014. Available at: http://www.mayoclinic.com/health/pacemaker/MY00276/DSECTION=risks. Accessed October 9, 2013. Available at: http://cdn.intechopen.com/pdfs/13786/InTech-Common_pacemaker_problems_lead_and_pocket_complications.pdf. Accessed March 14, 2014. Pat. A Heart Healthy Diet for Pacemaker Implant Recovery. November 10, 2008. Available at: http://www.diethealthclub.com/blog/diet-tips/a-heart-healthy-diet-for-pacemaker-implant.html. Accessed October 9, 2013. Available at: http://health.sjm.com/arrhythmia-answers/treatment-options/implantable-devices/pacemaker. Accessed October 9, 2013. Available at: http://www.pacemakerclub.com/public/jpage/1/p/story/a/storypage/sid/13421/content.do. Accessed March 25, 2014. Available at: http://www.ehow.com/way_5601960_implanted-pacemaker-dental-precautions.html. Accessed October 9, 2013. Eberhard, J., Stumpp, N., Ismail, F., Schnaidt, U., Heuer, W., Pichlmaier, M., . . . Stiesch, M. (2013). The oral cavity is not a primary source for implantable pacemaker or cardioverter defibrillator infections. Journal of Cardiothoracic Surgery, 8, 73. doi:http://dx.doi.org/10.1186/1749-8090-8-73 Available at: http://www.ehow.com/way_5601960_implanted-pacemaker-dental-precautions.html. Accessed October 9, 2013. Available at: http://www.bostonscientific.com/lifebeat-online/assets/pdfs/resources/ACL/ACL_Dental_Equipment_020209. Accessed October 9, 2013. Thompson, S. A., Davies, J., Allen, M., Hunter, M. L., Oliver, S. J., Bryant, S. T., Uzun, O. (2007). Cardiac risk factors for dental procedures: Knowledge among dental practitioners in wales. British Dental Journal, 203(10), E21; discussion 590-1. doi:http://dx.doi.org/10.1038/bdj.2007.889 Jowett, N., Cabot, L. (2000). Patients with cardiac disease: Considerations for the dental practitioner. British Dental Journal, 189(6), 297-302. doi:http://dx.doi.org/10.1038/sj.bdj.4800750a Schulmeister, L. (1999). Pacemaker interference. Nursing Management, 30(3), 14. Retrieved from http://search.proquest.com/docview/231428997?accountid=14752 Available at: http://www.bostonscientific.com/templatedata/imports/HTML/CRM/A_Closer_Look/pdfs/ACL_CPR_and_External_Defibrillation_063008.pdf. Accessed March 18, 2014. Jevon, P. (2012). Defibrillation in the dental practice. British Dental Journal, 213(5), 233-5. doi:http://dx.doi.org/10.1038/sj.bdj.2012.778

Essay --

Introduction Hyperlipidemia is a condition that effects hundreds of millions Americans every year. Hyperlipidemia is an excess of fat like substances in the bloodstream that include cholesterol and triglycerides. Hyperlipidemia is a condition that shows no symptoms and can only be diagnosed through blood tests. The treatment is aimed at lowering the LDL cholesterol, which is bad cholesterol. A variety of medications are used in the treatment including statin drugs, fibrates and bile acid sequestrants. Overall the condition is treatable with the right lifestyle modifications and overall healthy diet. Hyperlipidemia Hyperlipidemia is an excess of fat like substances in the bloodstream that include cholesterol and triglycerides. Fat like substances are also called lipids that seem to create chaos in the arteries and overall in excess are not good for a patient’s body because they are known to clog a person’s arteries which lead to many other diseases and conditions that are much worse, including a heart attack. Lipoproteins like the LDL (low density lipoproteins) and the HDL (high density lipoproteins) are the fat like complexes in the blood. Hyperlipidemia can be further separated into two subcategories including hypercholesterolemia, which means a high level of cholesterol in the blood, hypertriglyceridemia, which is a high level of triglycerides in the blood, which is the most common form of hyperlipidemia. The treatment of the condition is aimed at lowering the bad cholesterol in the blood. Diagnosis The overall diagnosis of the condition is based on the patients’ medical and lifestyle history before they are to access the patients’ lipid profile. The doctor would want the patient to also be healthy and... ...iarrhea, stomach pain and skin rash. Lopid is a very effective medication in the use of hyperlipidemia by lowering the levels of cholesterol and triglyceride levels at a reasonable price. Conclusion Hyperlipidemia is a common condition in men older than 45 and women older than 55 that affects the amount of cholesterol and triglycerides in the blood. It is also more prevalent in people with a family history of the condition. Hyperlipidemia is diagnosable by blood test to check unhealthy lipid levels in the bloodstream. Patients with this condition can either help themselves by following the recommended treatment or it will lead to more serious conditions like cardiovascular disease and even heart attack and stroke. Hyperlipidemia is a treatable condition with lifestyle and dietary modifications used concurrently with lipid lowering agents on the market today.

Organization Theory and behavior-power and authority Essay

Achievement of organizational objective depends on organization structure which is dynamic. Organization structure defines the flow of power and authority geared toward a particular course of action directed by organization’s objective. For organization structure to help to organization objective it is dependent on the employees. Employees operation are guided by the organization supervisors, whose their role is defined in the organization structures. Supervisor operations are dependent of power and authority which help to ensure things in an organization are done in the right way as well as achieving organization goals and objective. In organization management power and authority are very important as they help the organization to be able to direct organization employee toward organizational goals. Power and authority are dependent on the leadership model in an organization. Organizational managers are the leaders who employees report to hence their performance is dependent on the leadership offered by the manager. Achievement of organizational goal shall only be possible if power and authority are employed effectively. Authority and power helps the management to be able to create a productive culture through social process to guide employees’ capacity towards attaining organization goals and objectives. Power and authority helps the leader â€Å"†¦to create, maintain and improve a culture so that people will achieve objective (purpose) and continue to do so over time†¦Leadership in an organizations is a more specific process of influence since it involves goal that have been specified and can be measured or at least evaluated achieved only through employment of power and authority)† (Macdonald, Burke & Stewart (2006) pp 80). To influence employees toward organization goal, management can employ three ways according to Macdonald, Burke & Stewart (2006). That is force, manipulation and persuasion. Use of force by the management involves employment of force as well as real application of physical force to compel employees to work. Concept of force requires power to as it call for imposing one person against other employees, often referred to as coercion. Manipulation takes form of social distortion which direct requires the subject to do as they are told without asking questions. Manipulation is different force in that there is no coercion and employees are convinced that they are doing the right thing. Persuasion in an organization attempt to influence the employee to act in a certain way geared towards achieving organizational objectives without force or manipulation. It is dependent on will of the employee and mutual trust. Employment of force manipulation in an organization is dependent on the power and authority bestowed to the various leader or supervisors in the organizational operations. In an organization, authority is provided for by the organizational structure. Organizational structure grants an outline formal distribution of authority in an organization. Authority in an organization is largely provided for by formalization meaning standardized as well as rule and regulations that govern employee operations. Formalization defines the discretion in which an employee can act in his/her duties. â€Å"In an organization with high degrees of formalization, job descriptions and policies provide clear direction. Where formalization is low, employees have a great deal of freedom in deciding how to conduct their work†. In an organization different department exhibit different degree of formalization which may be base on the qualification of the employee to the organization affairs or rank of the employee. Authority is related to power in that it legitimizes supervisors to be able to direct and control subordinates to the intended course of action. Authority helps the supervisor to make decision geared towards organizational objective. Organization has three form of authority namely line authority, staff authority as well as team authority all distributed in the organizational structure. Line authority refers to straight supervisory form superior to subordinate organized such that it flows from top to the bottom of organization structure. Organization structure gives the chain of command which is unbroken line of command defining the decision, making process within an organization. Chain of command defining the authority of different personality in an organization helps employees to know who they are answerable to. This helps to avoid problem of duplication organization activities which comes due to more than one person assigning duties. Line of authority which is the basis of chain of command is linked to line department which are directly connected to production and sales of the organizational products. Examples of line department are marketing and production responsible for performance of the employees and reward. Staff authority as compared to line authority is more pegged to authority to advice base on the expertise and involves advising line managers. Employees help the line departments in coming up with the advices to be used for decision making but they lack authority to make the last decision. Staff supervision through suggestions made by line department decides on what is to be carried in the line department, coordinate as well as provide technical assistance. Team authority is executed by work teams responsible for daily operations in an organization. It comprises of groups of operating employees responsible for coordination of the organization operations. Team based structure as define under team authority in an organization organizes separate functions based on the overall organizational objectives. Authority is dependent to power such that for a supervisor to be able to get things done in accordance to the objectives of the organization power is required. â€Å"Everyone has power in one form or another and it is by exercising this power that organization get thing accomplished. Supervisors who are capable of achieving their objective independently of others are said to possess strength†. To be able to include people in the plan as well as organizational activities, supervisor requires power to get organizational things accomplished. Therefore, power is capability to apply influence in the organizational ahead of authority. This is gotten from the position as established by the organizational structure. In an organization a legitimate power bestowed to various leaders in an organization is established by individual position according to organizational hierarchy. Other forms of power include coercive power, reward power, expert power, referent power as well as information power. Supervisors’ power toward course of action depends on influence in the organization giving authority which may be centralized or decentralized. Centralization means the decision making power is concentrated on top of the management while in decentralization form of decision making authority is in lower level of employees. Relation of authority and power is that authority is the legitimate power of a supervisor to be able to direct employee to a certain course of action in accordance to organization goals. In a nutshell authority is a form of power delegated from the organization main authorities to subordinate.

The Canadian Health Care System - 1531 Words

Introduction Emergency departments are considered an important aspect of the health care system. For many years, wait times have been an area of concern for many Canadians and remain a significant issue. One of the major concerns within the Canadian health care system is the amount of time spent as waiting time in the healthcare services. Wait times are the length of time from when the patient is triaged and registered, to when the patient leaves from the emergency room (Affleck, Parks, Drummond, Rowe, Ovens, 2013). Whether waiting for a doctor, waiting for prescription medication, or even waiting to get tested, the reasons for wait time in Canada are caused by many factors (Cole, Hopman, Kawakami, 2011). This paper will seek to examine the factors contributing to longer wait times in the emergency department, examine the ways in which wait times impact society, and conclude by presenting possible solutions to reduce wait times. How Does Wait Times Impact the Society Waiting for medical attention is not a friendly process. The process can have serious consequences for both patients, and those working within the healthcare system (Barua, Esmail, Jackson, 2014). Delaying access to health care may cause increased pain and suffering in patients and could even lead to severe mental health consequences (Barua, Esmail, Jackson, 2014). Waiting for health care can also lead to economic consequences, such as reduced productivity, reduce the ability to work for an individualShow MoreRelatedThe Canadian Health Care System1111 Words   |  5 PagesThe Canadian health care system is often touted as a better health care system compared to the way the United States administers health care since the two neighboring nations appear to be economically and socially similar. The U. S. and Canada have extensive health care systems for it citizens but each country has different methods to financing health care. 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Medicare was the first government controlled, comprehensive, universal single payer medical insurance plan in Canada. Many insurance industries and all the medical institutions were against the idea of having Medicare. They feared that Medicare will become popular and will spread across the globe. OnceRead MoreThe Canadian Health Care System1823 Words   |  8 Pageshealthcare reform across the globe, including Canada. The Canadian health care system is called Medicare and can be described as a single-payer system. In essence, the majority of Canadians receive health care through a publicly funded system that consists of federal transfers to the ten provincial governments who then decided how the money is to be allocated in conjunction with the federal health care standards. These standards were set by the Canada Health Act of 1985 (henceforth â€Å"the Act†), which states