Reference no: EM133711625

Question

Mary Johnson is a 90-year-old woman brought to the hospital by her daughter with complaints of with fatigue, dizziness, and confusion. On initial assessment, Mary was oriented x 4, pale and weak. VS were HR 33, RR 20, pulse ox 94%, BP 96/70, and T 98.2F. An ECG shows Complete Heart Block (CHB). CHB, also called 3rd degree block, is a serious bradycardia. It occurs when none of the electrical impulses that originate in the SA node, atria, or AV node reach the ventricles. As a result, a ventricular cell is pacing the heart. The patient's cardiac output is compromised and the ability to perform ADLs is usually limited. Without treatment the heart will cease beating. The one-year survival rate is 50% if no pacemaker is used. Mary has a do not resuscitate order written by her primary care physician. She is negative for acute MI. The cardiologist is recommending a permanent pacemaker to treat Mary's condition. Mary has an advanced directive that states no artificial life support. She had a sister who had a severe stroke and was unresponsive on mechanical ventilation for 2 months. Mary states she does not want to be kept alive on machines like her.