Posture and Activity For patients with pacemakers, the previous practice was to stay in bed for 2 weeks, lie flat for the first 1 week, and then keep the left position. The limb implanted with pacemaker needs absolute braking to prevent electrode displacement. Through nursing observation, the author found that patients lying in the hospital bed for a long time after operation, the heart burden increased, and the shoulder joint could not move, which easily caused urinary retention, constipation, joint stiffness or pain. In recent years, by improving nursing methods, patients have been kept in the lying position for 24 hours and their activities have been restricted. Instruct patients to take a semi-recumbent position for 24 to 48 hours. After 48 hours, the head of the bed was raised by 65,438+05 ~ 45 degrees, and the patient was allowed to get out of bed after 72 hours. Bedside chairs were used in the early days. If the condition is stable three days after operation, you can use the bedside chair for 65,438+00 ~ 20 minutes every day. Walking activities can promote postoperative rehabilitation. You can walk on the bed in the early stage, then walk in the ward for 5 ~ 10 min, and then gradually extend the time, twice a day, with medical gymnastics and Tai Ji Chuan. Exercise intensity should be moderate, not too fast. At the same time, the patient is instructed to do appropriate front and back movements of upper limbs and shoulder joints, but it is not advisable to do activities with large vibration or excessive force. 2.2 After skin care, the incision should be changed to prevent the wound from being exposed for a long time, and the environment should be disinfected. The choice of seasonings should be strict, and the ingredients with unclear ingredients should be avoided. Observe the skin color, and often observe or instruct the patient whether self-observation has bleeding or hematocele. If redness, swelling, heat and pain occur, antibiotics should be used immediately. When hematocele and effusion appear, incision, drainage and washing should be carried out. Squeezing is prohibited to prevent infection from spreading deep along the electrode lead. Increase the skills of protecting the capsular bag and use the pacemaker, especially for people with thin figure, to reduce skin tension and promote wound healing. Apply the "three-finger method" to self-care the skin, that is, after removing stitches, fix the skin with one hand, clean the skin with the other hand, and wear soft underwear. Female patients should pay attention to prevent bra straps from rubbing against the skin, and it is forbidden to scratch the skin or pick up or push the pacemaker. 2.3 The ECG changes after postoperative ECG monitoring are multifactorial, and the abnormalities of pacemaker and sensory function are mostly intermittent. After 72 hours of routine monitoring, especially in the first 24 hours, closely observe the oscillometric changes. Observation: whether there is pacing signal, heart rate change and arrhythmia. In addition to routine ECG monitoring, routine ECG monitoring and remote monitoring, 24-hour DCG monitoring is the first choice at present. Geng Renyi believes that DCG monitoring lasts for a long time, and there are many opportunities to find abnormal pacing function, especially those with pulse marks, which are more helpful to analyze abnormal pacing function. DCG can be considered as a routine examination after pacemaker implantation if conditions permit. In addition, we should pay attention to the measurement of pulse or heart rate 2-4 times a day, strengthen the follow-up of patients with arrhythmia, especially the risk factors of atrial fibrillation, and master the method of analyzing pacing rhythm through ECG oscillogram, pulse and heart rate: whether or not the pacing signal of electrical signal indicates that the pacing threshold is increased, sometimes the pacing signal does not appear or disappear completely, indicating that the electrode is poorly fixed, displaced, partially broken or insulated, battery consumption, fixed-frequency pacing does not pace as needed, and the pulse and heart rate are lower. 3. Discharge guidance 3. 1 Strengthen psychological counseling according to the performance of pacemakers. Because patients will face the problem of replacing batteries and electrodes, emotional support should be given in time. In addition, many patients are worried that the pacemaker will suddenly stop working, so the necessary explanation is the key to relieve psychological pressure. 3.2 Teach patients the common sense about pacemakers, and teach them the installation time, model, working mode, heart rate, living arrangement and self-checking pulse method. The heart rate per minute shall not be lower than the pacing heart rate. Precautions for going out: Patients should carry relevant medical materials and personal information cards with them when going out in case of emergency. 3.3 Prevent the influence of social environment on pacemakers 3.3. 1 When radiotherapy is needed due to the interference of hospital environment, please consult an expert and try not to use a linear accelerator. Any radiotherapy method should ensure that the pacemaker is irradiated in the irradiation field and ECG monitoring should be carried out at the same time. After radiotherapy, the performance of pacemaker should be tested. When defibrillation is needed, it is best to use the front chest and back electrode plate, the distance from the pacemaker is >: 10 cm, the discharge direction should be perpendicular to the pacemaker, and the low energy discharge should be used as much as possible, and the pacing threshold should be monitored after operation. When using electrosurgical excision procedure, a permanent magnet should be placed on the skin of implantable pacemaker, so that the reed switch in pacemaker can be attracted by the magnet and converted into asynchronous type to reduce current interference. Sun Yafang reported that this method effectively protected the normal performance of pacemakers in the electrosurgical operation of 3 patients with pacemakers. 3.3.2 Interference of home working environment Electrical appliances used in daily life must be grounded correctly, and leakage is not allowed, and attention should be paid to keeping a safe distance between high-voltage electricity and anti-theft equipment > 167 cm. In order to prevent interference from mobile phones, use analog mobile phones, avoid using GSM with the strongest interference, and do not put the opened mobile phone near the pacemaker implantation site at least 10 cm away, and avoid putting the mobile phone in the pocket near the pacemaker. Don't point the antenna of the mobile phone at the pacemaker socket, and the distance is better than 20 cm. Use the mobile phone to the ear. Don't get close to mobile phone users in restricted environments, such as elevators and buses. Pacemaker-dependent people should check and keep a clear understanding when using their mobile phones, and remove their mobile phones in time in case of interference. 3.4 Follow-up Actively publicize the necessity of follow-up and enhance patients' awareness of follow-up. The author requires that every 65,438+0 patients with pacemakers should go out for 2-3 times in cardiovascular clinic within 3 months. From 3 months to 1 year, check 1 times every 1 ~ 2 months, and then check 1 times every 3 months. When the pacemaker is limited, the follow-up time should be shortened. If you have palpitation, chest tightness, blackness, pulse lower than natural pacing frequency or irregular rhythm, you should seek medical attention immediately.