First A Nurse: No Matter Where, No Matter What | Page 23

“I don’t want a pacemaker,” 78-year-old Harold said as he
sat with his wife and three daughters in the family nurse
practitioner’s office discussing his recent tests and the
implications of the results.
Harold lived with multiple chronic health issues. He had been
brought to the office a few weeks earlier by his wife and
daughter, who noticed symptoms of episodic “slumping.”
Every now and then, he would slump down in his chair and
seem tired; he would then perk up and be back to normal.
Concerned about his heart rate, the Spartan Nurse, who
had been caring for Harold and his family for more than
20 years, ordered a Holter monitor. Results showed episodes
of Harold’s heart rhythm going into an ominously low
junctional rate of 32 beats per minute—compared with the
normal 60–100 times a minute. His “slumping” episodes were
likely due to a very low heart rate.
The cardiologist suggested Harold get a pacemaker.
The Spartan Nurse helped navigate the family through
this life-and-death decision.
Developing a Plan with the Family
Julie Thomas-Beckett called a meeting with the family
to explain the Holter monitor and share images from the
electrocardiogram. She informed them that this could
happen again—and that Harold could die from this condition.
The first step to remedy this would be to change some of his
medications in an attempt to help the heart work optimally.
She informed them that these types of heart rhythms were
often corrected with the su